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HomeMy WebLinkAboutBuilding Permit # 5/17/2016 %AORTH BUILDING PERMIT 0...... TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PernnitNog. VA-L-?,o� Date Receivact T__ I 9SSacHusEt Date Issued: ——------..........................- M ---------------....................... -11�complete all items onthispage LOCATION Print PROPERTY OWNER Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT:........... Historic District yes r(K I Machine Shop Village yes -----------_-1------------....................... TYPE OF IMPROVEMENT PROPOSED USE ResidentialNon-Residential- -----------——--------------------—----------- 0 New Building rWOne family 11 Addition D Two or more family 0 Industrial F1 Alteration No.of units: 0 Commercial —-------------------- ,KRepair,replacement D Assessory Bldg F] Others: 0 Demolition D Other ——Wataislied Distract isk J DESCRIPTION OF WORK TO BE PERFORMED: ........... -----—-——-----------—------- --------------—---——-------------——----------—------ Identificati Please Type or Print Clearly OWNER: Name:. ...................... Phone:q Address: :?3ryza2kil. Contractor Name: Phone: 2e",y_? Email: 4k Address: kL_&1411_ Supervisor's Construction License:r',- Exp. Date: Home Improvement License. Z Yf'722. Exp. Dt". _j_ ARCHITECT/ENGINEER Phone: Address: Reg,No. FEE SCHEDULE:BULDING PERMIT.,$12.00 PER$1000,00 OF THE TOTAL ESTIMATEDLCOSTEWSEUCM$125.00 PER S.F. Total Project Cost:$ — FEE:$ '- Check No.: Receipt No.: 7s with unreg t the guaranty farad NOTE: Persons contracting w tered ed contractors do not have access to � _St nature of R VORTy Town of Andover ® ' h vet-, Mass, CL �9 A�Rareo WrPa��S `s UBOARD OF HEALTH Kin FoodKitchen mr" ERIWII�T El L 'LF'ft; Septic System BUILDING INSPECTOR THISCERTIFIES THAT......................................................................................................................... Foundation has permission to erect..........................buildings on ugh 4bV t0 be OGCUpled as.......... 0 ....... ......�in ................................................................................. Chimney provided that the person accepting his permit severy 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 UNLESS CONSTRUCTION STARTS Rough q/n Service t' 1..BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Per^tnit Required to Occupv 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 Approved by the Building Inspector. Burner Street No. Smoke bet. Page No. of / Pages ..................... Supervisor CS 068461 Fully Licensed&insured Home Construction Reg.#146722 �R A Roof %7r- 331313 1 Mg ---M -- c2eirta-nTe edIM North Reading, din& AA A. COCTId 978-276-3043"�EWOpos�,SUBMITTED PHONE_J08 NAME ............ ----- CIN STAI=ODE JOB LOCATION We hereby submit specifications and estimates for: Recommended Optional (Included in price) (Not included in price) ............----------------------- ----- Rip&Remove all shingle debris from root&job site -it/y,; layers .0 layers or more -------------------------—--------------------------------- .................... Repair/or Replace any roof decking;not to exceed 50sq.ft. -------------- Install 8"aluTinum drip-edge/and rake-edge along entire perimeter.Choice of mill Cw brown .......................-------------------............. _whit or Install ICE&WATER underlayment along horizontal eaves,valleys,sidewalls-and sky-lights&chimneys ------------------ -----------4�1 5 qy Install premium base sheet underlayment between roof deck and roofing shingles ......lb,felt U 30#.felt ................Install 25yr Certa:inTeed/GAF/IKO_traditionalI 5-tab roof shingles J.30 year -------------- iiu/ Install CertainTee KOctural Lifetime..............------ ime roof shingle ......................... ----- .... .............. ---- . -- -------------- ---------- ---------------------------....... ................ ­-------- See manufacturer warranty policy for more details V Install new aluminum vent-pipe flange(s) Chimney(s)-counter-flash and re-step existing flashing ---—------------ J Cut&Install new lead flashing -R-i--d-ge-ven-tl-e-xha—ust-vent-with-low profile design,hidden by shingle caps —---—---------------------­ -------------------­­­ Ul Soffit ventilation J Roof-louver-vents.................... • Seamless style aluminum gutters-custom fabricated at job site -------------------­..................................I-------------- ........................-------- :1 downspouts ............ —-------------- • Other --------------—-- —------------ --------------—--—---------- -- ---------------- —------------ —---—--------------—----------------- —---------- ...........................—-----------------------­.......................... .......... ------------- ----------------------—---------------------- —--------- .....................--—------------------­­­­- -------------- .................... ------ O'Keefe roofers will properly dispose of all roof debris in our own dump truck. —-- --------­-------------------­.-—--—--------------........................_--------- ------ *Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-off ---------------- ---—-------------- ---­----- Price --Price includes all items above that are-checked-only/others maybe priced separately upon request_ ­ Uh Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: Total price not including options.dollars($ ------------­........ Payment to be made as follows: 30%deposit required upon delivery of materials,Balance due in full upon day of completion. ---------------­­­-�------------------ —--- ---------_.-_. ............... Please make all payments out to Michael O'Keefe,21 Francis St.,No.Reading,MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized completion. Signature -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract. withdrawn by us if not accepted within days ---------- The Commonwealth ofMassachusetis Department oflndustrialAceldents d 1 Congress street,Suite 100 - Boston,MA 02114-2017 www.rnass.gov/dia +4 Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO B1;+M LL'D WPrH THE PER1VI17.'TJNG ATI'rHOR1TY. Applicant Information Please Print Le 'bl e Name(Business/Organization/fndividnal): c Address: _S7��-/1 ,s�n _S7- City/State/Zip: Phone#:_11 2 1G "3 6-/3 Are you an employer?Check the appzoprixfu bo Type of project(required): I, am armployerwith�._canployees(full and/orpart-time),* 7. Q New construction 2.01 am a sole proprietor or partnership and have no employees working for me in S. El Remodeling any capacity.[No workers'comp.insurance required.] ' 9. El Demolition 3.Q I am a homeowner doingall work myself We workers'comp.insurance required.].t 10❑Building addition 4.Q I am a homeowner and will be luring contractors to conduct all work un my property.twill ensure that all contractors either have workers'compensation insurance or us sole 11.Q Electrical repairs or additions propiietom withno employees. 12..0 Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-cou motors listed on the attached sheat. ❑ 13,KRoofrepairs 'These anb-contractors bade employees andhave workers'comp.insumnne.t 6.E]We are acorporetion and its,officers have excrcised their right of'exemption perMG1,c. 14.Q Odder 152,§1(4),and we have acerr oyees.[No workers'comp.ireuraneerequii r: `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t I3maeowners whosubn£ifdt s affidavit indicating they are doing all workand then hire outside contractors must submit a new affidavit indicating such. tCooto etors that check this box most;attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.If the sub-conlxactors havo employees,t4ey mast provide their wo lows'comp.policy number. Iran an employer that is pidviding workers'compensation insurancefor my employees.Below is the policy and job site information. Insurance Company Name: y� 'c.#1:_-V'l'lJ(',-/CrG....`/_ o1 r ?" Expiration Date: Polie #or Self-ins.Lie. �/✓;, ,>a?-,/t"�� Job Site Address: > G�oa2/f.2�L _1 _ City/State/Zip:, �b_[! ' .1/-rA?_ Attach a copy of the workers'compensation 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 fide up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD.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. X do hereby certify underdliepains and penal�tie'/s/�"}'perjury Heat the deformation provided above is true andcorr�erct � -- --Date: AIV '5�1e"'�q,7 Phone#, YYY- CYL� Official use only. Do not write in this area,to be completed by city or town offrcial.. City c r Town: _ ___Permit/L icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: -- — ^_Phone#: _-- YAY/17/2016/TUE 03:39 PM AuK FOWLER INSURANCE FAX No, 9786642209 P,p01/001 i05'C"1z" CERTIFICATE OF LIABILITY INSURANCE DATE(MM(ODIYYYY) 5/11/2016 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 policylies)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 CONrAC NAME: A 6 K Fowler Ina uranCe JAICNNo,,H (978)664-0366 (q(C No):(9T8)6fi9-2209 200 Pa,Ck St. EMAIL ` ADDRESS: _INSUR ERfS)AFFORDINGCOVERAGE NAIC4 North Reading MA 01864 INSURERA:Western World Insurance .................... .............__ __ .__________ INSURED INSURERS: O'Keefe Roofing LLC INSURER C: 21 Francis St. INSURER D' INSURER E North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1591110313 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR FUERC EFF POLICY E%P LTR TYPE OF INSURANCE POLICY NUMBER MMIDOl1'1'YY MMIDDIYWY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMB-MADE '',X OLCIIk PREM ISF..S Ea occF�rre� $ 50,000 ........... %PP1404384 9/8/2015 9/8/2016 MED EXP(Any one person) IT 5,000 PERSONAL VINXRY $ 1,000,000 GEN'LAGGRE3ATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 XPk0_ -............................... POLICY .;FCT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 _' OTHER: $ AUTOMOBILE LIABILITY FMccd SINGL.. LIMIT $ eIi] ANY AUTO ©ROILY INJURY(Per pgrspn) $ ALL OWNED SCHEDULED EODIL.V INJURY Poraulden[) $ AUTOS AUTOS _ I NON-OVJJL:DFROFFRTY DAMAGE $ HIRED A{)TOS AUTDS Per aocidant UMBRELLA UAB OCCUR EACH OCCURA.ENfE $ EXCESS"AS CLAIMS-WADE AGGREGATE $ DED RF.TEW DNS $ WORKERSCOWENSATION PFR GIH- ANDEMPLOYERS'LIABILITY Y/N .STATt1TE. GI ANY PROPRIETOROARTNER/EXECUTIVEWorkers Compensation cert F_.I..EACH ACCIDENT $ OFI7ICER/MEMBER EXCLUDED? N/A (Mandatory in NH) to follow saperetely. E.L.0 SEASF-EA EMIR OYEL$ fgI.desrribe under -------------------- DESCR IPTItJN OF OPERATIONS below EL.DISEASE-POLICY[IMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Addld*nM Remarks Schedule,maybe attached Ifmore space is required) Insurance verification - Please refer to actual policy for all other terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 11ain St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, IIP. 01645 AUTHORIZED REPRESENTATIVE Nicoj..e Or.lanzc/NMO . ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) }�AY/17/2016/TUE 03:41 PM A&K FOWLER INSUE,ANCE FAX No. 9786642209 P, 001/001 f�A/^ Q DATE(MMIDDM'YY) I,, CERTIFICATE OF LIABILITY INSURANCE 05/11/2016 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 CON rAc' NAME: Nicole Orlanzo BYETTE INSURANCE AGENCY INC. PA",$" Fxt (978)851-6678 ac Ne: E-DRESS:MAIL moole akfowlerins.Com AD 200 Park St. _ .INSUREILS)AFFONONGCOVERAGE NAIC# ...... .... ........ .. North Reading MA 01864 INSURENA, AIM MUTUAL INS CO 33758 INSURED — __ INSUREftB--_____.—_____.._______—__..____________ ---- ______________________________ _________ OKEEFE ROOFING LLC INSURERC: INSURER O: 21FRANCIS STREET NORTH READING MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER: 51968 REVISION NUMBER: THIS IS 70 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. /NSR TYPEOF INSURANCE AOOL SUDR PCUCYEFF POLICYEXP LTR POLICY NUMBER MwDDIYYYYI IMMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCI:RRFNCF_ $ OAIJIFlC,,E'O FENTFD GIAIMS-MADE OCCUR _PRF-MISES F_a ocwrrence $ MED EXP(Al,one person) $ N/A PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMJT APPLIES PER: GENERALAGGREGATE $ POLICY n JECT `�LOC PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOSILEDABILIT'Y COMBINED SINGLELIMIT $ Ea_6JCen_�___ ANY AUTO BODILY INJURY(Per parson) $ ALL 0WNEU `0 FOUL AUTOS AUTOS ED N/A 600ILY INJURY(Por accidonl) $ ----- -----NON-OWNED -PRtSPERTV DAMApE---� $ HIREDAUTOB AUTOS Per--0 UMBRELLA LIAB pCCVR EACH OCCURRENCE $ E%CESS LIAB CtAIMB-MAUE N/A AGGREGATE $ DED RETENTION$ $ WOWERS COMPENSAMON PER OTH- X STATUTE -_-ER--- -_ __ __ AND EMPLOYERS'LIABILITY --------- ANYPROPRIETORIPARTNERIEX ce-EY!" E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBFRE%CLUDED? NIA NIA NIA VWC10060178842015A 10)121201$ 10/12/2016 (Mn NHI EL pIBEABE-FA EMPLgYEE$ 500,000 DESCRIPTION OFIOPENATIONS below El.DISEASE-POLICYLIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AtlQtivnal Remarks Schedule,maY be attaclrad if more spots ix 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 w .mass.govAwd/workers-compensabon/investgations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St. AU TN ORIZED REPRESENTATIVE North Andover MA 01845 (-1yI� Daniel M.Crowley,CPCU,Vice President--Residual Market--WCRIBMA O 1988-2014 ACORD CORPORATION.All rights reserved- ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD rZ. Orrc of Consumer AfGirs&6 a �,"'!'ma�'!��/,. Massachusetts Department of Public Safety Jx3N7ir1�9M�raMoROVEMENT CONTRACTOR guon ® Board of Building Regulations and Standards {xJHNn lei 146722 License:CSA68461 irExp atwn: 5/11/2017 Type' Construction Supervisor �FEFE CONSTRUCTION DBA - /Ch MICHAEL J OKEEFE 21 cRAi O'KEEFE 21 FRANCIS STREET NORTH READING MA 01664 NCRrh 4 7 NGSTREET MA 01864 Undersecretary (,A— Expiration. Commissioner 0212412018 Construction Supervisor License or registration valid for individul use only Restricted to: before the expiration date. If found return to: Unrestricted-Buildings of any Use group which contain less than Office of Consumer Affairs and Business Regulation enclosed spac00 cubic feet(991 cubic meters)of 10 Park Plaza-Suite 5170e. Boston,MA 02116 0,41-vii Not valid wi[ ut sign-,rfu re/ Failure to possess a current edition ofthe Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit:WWW.MASS.GOV/DPS 4_