HomeMy WebLinkAboutBuilding Permit # 5/19/2016 Q4ORTH
BUILDING PERMIT ®�R4�ED 16"'
TOWN OF NORTH ANDOVER � -
APPLICATION FOR PLAN EXAMINAT[0& ..:::
Permif No#: Date Received;
."ss Cwus�c
Date Issued:
1
41P—OR—TAIXNIT: Applicant must complete all items-`an tbisipage
LOCATION �co✓� �'�l
• *N &2y
PROPERTY OWNER
Print 100 Year Sfrueture yesno
MAP PARCEL: ZONING DISTRICT:_ Historic District ye no
Machine Shop Village ye 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
� „Se tie�4 ❑UUell , �` ❑ Floodplain D Wetlantls r ❑ Watershed District
a a`r.1�%;`�,`-.sh�,�n'� rn.,v; ;f: ( !/, `�n'_:r Pr±.l�'�r 1 r,'r��. r ani y,, ,,,,, %ft/ ' ° ✓,. t�.uy �I , t c,'��5 i�l / r. � T ,-.
DESCRIPTION OF WORK TO BE PERFORMED: r
I} r
Identification- Please Type or Print Clearly
OWNER: Name: H-/,J �o d Ll, C Phone:
Address: S V�✓fi s -�'� �� -
Contractor Name: J'� N Nc3,2� � j Phone: `� 62-f Lo
Email _ i7 ", ,a
Address:
Supervisor's Construction License: Exp.. Date: /
Home Improvement License: I K( 9 ( 3 Exp:.,Date l j
ARCHITECT/ENGINEER Phone:
Address: Reg..:q..
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED 0OST...fr E# E7X.$925.00 PER S.F.
Total Project Cost: $_ FEE: $
Check No.: Receipt No.e; . 0 � �
,MOTE: Persons contracting with unregistered contractors do not have ic�eess o,tFie guaranty fund
^T._ - — — - -- -
tjORTH
Town of Andover
® � t
No. C�J
Y' �O LA�cE \ ver, 6�.SS,
�'� COC MICMEMCK
s RgTED �P���S
Nor- U BOARD OF HEALTH
LDFood/Kitchen
PtR ISeptic System
THIS CERTIFIES THAT ® ® BUILDING INSPECTOR
.. Foundation
has permission to erect buildings on .... ...4, . . 1. 4?.... ..................
.....................s.... Rough
tobe occupied as .............. ... ....... ............ ......... ..... ....... ............................................................. 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
..
.............. -..... .. ...""'/i .......................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy Buildin Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No LathingOr Dry Wall TO Be Done FIRE DEPARTMENT
Until Inspected ve the Building Inspector. Burner
Street No.
Smoke Det.
E ZS
Apex Roofing & Restoration LLC
3 Easy 5t.,Westford, MA 01886
Phone:978-692-8900 Fax,978.692.8828
H.I.C.#181413 CSL#061982
Info@apexroofer.com
r,ane:Patricia&Jerry hers ` cells:978-314-1277 Homer:
Address:58 Saunders Per St" b eel nha�_ rdv0�Cwerizon.net
c^y North Andover state:MA JoAdd,aee:Same
We herebystrbmh specirxat)ons and estimates for:
All sections of entire roof except bay window&front porch.Also includes new EPDM system on top of roof.
• We will supply a clean roll off container and place lumber under the container wheels to prevent damage to the driveway.
• We hang tarps to protect your property and strip all layers of roof related debris.
• Replace all existing bathroom louvers and soil pipe flanges.
• Re-nail your existing sheathing with 8d ring nails.This extra step will ensure that your sheathing does not x;v.p'in the future,
Install CertainTeed :?`/. s ; !;, granular ice&water shield or equivalent on all side walls,valleys,skylights,and chimney
flashing.Massachusetts building code calls for 3 ft.of ice&water shield on horizontal eaves... We double it to 6 ft.1
Install Synthetic Underlayment(25x stronger than felt paper)in all areas not covered by ice&water shield.
• Install 8"aluminum Drip-edge/Rake-edge along entire perimeter(choice of white,brown or mill finish).
• Install CertainTeed starter shingles in order to ensure proper edge adherence.
• Install CnnsumerReports recommended CertafnTeed f.sr)dnv4?:k architectural shingles(6 nails per shingle for 130 mph wind warranty).
• Cut 21'opening at all ridges and hand nail CertainTeed liOgioVbnt ridge vent(e typical upgrade forother roofing companies).
• Install CertainTeed cap shingles on all ridge and hip locations.
Clean up&perform a magnetic sweep of property.Remove debris from gutters&downspouts(if existing).
• The roll off container will be picked up in a timely manner upon completion of the project and hauled to a recycling facility.
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Unlike our competitors we do not offer high pressure time related coupons.Please call or e-mail us with any questions.
Payment is due in full upon completion of job We accept cash or check I+trti rrr'tNEY D.eG-r1`i'Nl
Apex Roofing&Restoration LLC agrees to all labor,material and building permit specified above for the sum of: $ 7,285.00
Notes:Any rotted plywood will be replaced for an additional charge of$1.80 psf for 1/2"plywood:
Any rotted roof boards will be replaced for an.additional charge of$4 plf(1x8"):
Out and install new lead flashing on brick chimneys for an additional charge of $595.00 per chimney:
ici ssi�� r l_a ip r� IN SNI� RIM�i11 r
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t '°� ' �"�"-A"j tlj`GSUIP�tLt_--r .t. .,*1� �, t,t.a�x.'i` :�L}: :.',a.7dx-.�.�°• r'4�y�tl^I'i L3��'�r1!f) ,y�i�qr .'c,if
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_• -m.. a yt-uuuarm m i a(" iaa a, u = n:,: $ {
_I..�sa;�tsn:...,.1.,•,,r._. i.--t=:..-..r ...., m. I_I.,,_:.-..._f��e.nx iftni!nn:l,otH,uitl _NO-�ilIgs.>;G . :
Contract Acceptance:Upon Signing,this document oecomes a binding contract under law.You may cancel this agreement provided you notify Apex Roofing&
Restoration in writing at their main office by ordinary mail posted not later than midnight of the third business day following the signing of this agreement.
perry ovVners Signature Date Shingle/Wor Selection
5/7116
Property Owner Signature Date Authorized Signature:John W Normandie III/owner Date Submitted
Note:This agreement may be withdrawn by us 0 not accepted within 30 days.
L abed 1,9LEOLb8L6 XWd'bU 9111 HJR Wd50-'b0 9602 EL AeW
S:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): oo" 2GJ
Address:
City/State/Zip: MA 01 Phone#: Gq 2 8 q(l&,Il
Are you an employer?Check the appropriate box:
Type of project(required):
I.®I am a employer with 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. E]Remodeling
any capacity.[No workers'comp.insurance required.]
3.0I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 9. ❑Demolition
4.❑I 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 11.0 Electrical repairs or additions
proprietors with no employees.,
12.0 Plumbing repairs or additions
5.�I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet.
'"'fffTTf������ a
These 13.❑Roof repairs
sub-contractors have employees and have workers'comp.insurance.t p �
6.[]We are a corporation and its officers have exercised their right of exemption per MGL c. 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.
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-contractors 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:
Policy#or Self-ins.Lic.#: / Expiration Date:
Job Site Address: , S6ku,7 news Y/— , Ac/1y P 417V01 0_�State/Zip: l)Ul'I &Z, E �
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 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 t e ai dena ' s ojperjury that the information provided abo a its true ylnd erect
Sianature: Date:
Phone#:
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#:
From Rapo 3epsen Insurance 1.508.875.5885 Tue Mar 15 10:06:05 2016 MDT Page 1 of 1
AT / ()ACCMD), CERTIFICATE FLIABILITY IN � N 3/08/20160
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 ort this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER NAMEAC ANDRE SILVA
RAPO&JEPSEN INSURANCE SERVICES INC PHCN o Ext: - - C No: 5-5885
191 CONCORD ST E-MAIL
ADDRESS: _
FRAMINGHAM MA 01702 INSURERS AFFORDING COVERAGE NAIL a
INSURER A;ESSEX INSURANCE CO
INSURED JDQ CONSTRUCTION INC INSURER 13:AIM MUTUAL INSURANCE CO
PO BOX 361 INSURER C:
FRAMINGHAM MA 01704 ENSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PFRIOD
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 TYPEOFINSURANCEADDLSU POLICYEFF PO ICYEXP LIMITS
LTR 1 POLICYNUMBER MMIDD IDNYYY)
GENERAL LIABILITY EACH OCCURRENCE $1,000.000
GE TO RE
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $50,000
CLAIMS-MADE a OCCURMED EXP(Any one person) $1,000
A 3EE2219 03/02/2016 03/02/2017 PERSONAL R ADV INJURY $1,000,000
GENERAL AGGREGATE s2,000,000 '..
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2.000.000
_
X POLICY JE� LOC $
AUTOMOBILE LIABILITY - r r Ea ax deD SINGLE OMIT $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED AUTOS SCHEDULED
AUTOS BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS-MADE AGGREGATE $
OED RETENTION$ $
WORKERS COMPENSATION X WC STAT J- DTH- j
AND EMPLOYERS'.LIAB1UTY YIN TORY LIMI S
B ANY PROPRIETORIPARTNEWEXECUTIVE❑ AWC40070314042015A 09/05/2015 09/05/2016 E.L.EACH ACCIDENT $1,00 000
OF .1MEMBER EXCLUOtD•? Y NIA F
(Mandatary In NH) E,L.DISEASE-EA EMPLOYE $1,000,000
If yes,describe under f'
E.LL DISEASE-POLICY LIMIT $1,000,000
TF
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(Attach ACORD 101 Additional Remarks Schedule,ifmore space Is reQ�Lulred
APEX ROOFING AND RESTORATION-LLC IS LISTED AS ADDITIONAL INSURED ON THE ABOVE GENE6AL LIABILITY POLICY,.
CERTIFICATE HOLDER p CANCELLATION
APEX ROOFING AND RESTORATION LLC SHOULD ANY OF THE ABOVE DESCRI D P I ES BE C LLED BEFORE
THE EXPIRATION DATE THEREOF, TI WILL DELIVERED IN
3 EASY ST ACCORDANCE WITH THE P LICY PROVISI S.
WESTFORD MA 01886
AUTHORIZED REPRESENTATIVENv_ff
r
01988-2010 ACdRP C
AhPOIRATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
�fe` iii�a�uirulerrftl n�GP�l�.tinc%rr/l�
Office of Consumer Affairs R Business Regulation
OME IMPROVEMENT CONTRACTOR
egistration: 181413
ELLC
xpiration: 4/1/2017 Type:
APEX ROOFING 8 RESTORATION LLC.
JOHN NORMANDIE
3 EASY ST
WESTFORD, MA 01888
Undersecretary
Massachusetts Department of Public
Board of Building Regulations Safety
License: CS-061982 and
SSttandards
ConstrUction Su B
pervisor
JOHN W NORMANDJE Ili
3 EASY STREET
WESTFORD MA 018mm
$
r
Commissioner er Expiration:
- 09/08/2017