Loading...
HomeMy WebLinkAboutBuilding Permit # 5/24/2016 `%o R Tpi BU ILDING PERMIT ®��zt�o q4 TOWN OF NORTHANDOVER �� y `�. '.•.._46 APPLICATION FOR PLAN EXAMINATION ® ' p Permit No#: Date Received 'li A�RRTED 0ea`�5 (( �SS�cHus�� Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER �C> Print 100 Year Structure yes no MAPMq_PARCEL: U 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 MIRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other :- �, n�, ,,,;.�� r r la n�� ��,:,�Weflands� �� ��� r ❑1 Watershed/DIStrIGt. ,���a ,.�w, C7 Se flc ❑uuelr � ❑ Flood t /fi. r - �.. 1 Gf. r. rc.� rrt rr i '.r i �: .i 2 ;s. :.: .,; rF rr✓.wr t f�.: �rt�r a. . ._,..,... .sv �- r`5^ r x ✓ ; 9 F. r .._ .... /� <,, �, a . .,.., .. / �r'T T__;tea;, �, ��,.., ...,,��r.. � ,..F. r ; ,.�.. >.,.,,r„+4,sem'. t` �c:. ; ��,._ `J :�m✓inf..... J� _.,x, .. r ,i l�'.�. iu. w; rr .an ,�, ,,sr�/� ���,r,n,ar,�✓ rr .:1}',r3�.i!. �;,1'� y"�u, .,..�. �f: F `�' ;..a. /r !i r,..r .' .�;'";k'i�J..;.. .� yx,�W.,, r r. d� rf r`:t ✓ r✓,:�:� ,.LN �,� .�` �r. rr�,",�/n':;'�r�-� �?;�. 7 -.� � --�9. ` 5 .arw �� r �. ;fr S .r,”, 4 � -;�;.✓t(�✓ �"%' ��"�.. f. F '-� ,fN a'. �. ,'Y"rr .z'`rs� � �,�. r Ps /r f � !.. ' >n: �`3J.r .v. -. Try i�f r w I- �'/y: � i ✓ .F x'�i ru, ✓ r .�w' /. x :L DESCRIFTION OF WORK TO BE PERFORMED: OWNER: Name: ��rint Clea�-,1. hone: � -0� Address: Contractor Name: PV Phone: Email Address: tS Supervisor's Construction License: Exp. Date: Home Improvement License: I C Exp. Date: c �c ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92,00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: � y1� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces o t guaranty fund t%O R TH Town oft ndover 0 ® - �. : ver, Mass, ® � LAMB COC MIC MQ WOC A N � \V S U BOARD OF HEALTH Food/Kitchen PER T D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ....... . . . . .. .. ......... .. .. ..... . has permission to erect ... buildings on ......... Foundation ......... .......... .... ....... ... .... ..... . . ... ' 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final EXPIRESPERMIT ELECTRICAL INSPECTOR UNLESS CONSTRUCT 10 N S TARTS Rough Service .. .......... :`.`::°.�.................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — ® Not Remove Final No Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Hays ate Roofers,Inc. Proposal P.O. Box 189 North Reading,MA 01864 Date Estimate# Tel. 978-664-0668 5/6/2016 16554 Fax 978-664-4333 — --_- -- ----- I-IIC# 137193 FN.Andover,Ma. me I Address CSSL# 99895 k stewart arblehead St. 01845 Bay State Roofers Inc proposes, re approximately . 1600 square feet of the existing asphalt shingle roof down to the wood decking. pp ew ice and water shield along the 6' roof edge,valleys and around all the roofpenetrations. ew 151V felt paper tlitoughout.roof a ea. ew white aluminum drip edge along the roof perimeter. Lifetime GAF Architectural asphalt shingle will be installed over the prepared substrate. ridge vent will be installed to ensure the proper roof ventilation. ecification f penetrations and flashing will be installed according to manufacturers recommendation, spails.uaninstall new lead flashing on the roof chimney. (1) Install new pipe flanges. ly dispose of all roof debris in our own waste containers_ Bay State Roofers will proper Any wood decking that needs replacement will be an additional$2.50 per lineal foot. Flat roofs will be done with poly glas rolled roofing. New Shingle Roof Add an additional$2550.00 to include the garage roof to match. (700sgft). Tear Off - Authorized Signature: Total $7,050.00. Waste containers supplied by Bay State Roofers,Inc. are for sole purpose of roof debris. 1Jri er iia circ-Ufffstg11ee�is the liotnecr iei to use tli se ct iitaiiiers fog personal use: 10 Year Workmanship Warranty on all roofs. (Except Repair Jobs) CONTRACT ACCEPTANCE The specifications,prices,payment schedule,are.satisfactory and.hereby accepted. Date' BAY STATE ROOFERS,INC.is authorized to perform work as specified. - Payment will be made as previously outlined. Signature All bills over 30 days are subject to 1 1/21/o finance charge per month(18% Color Pre r G r — annual). The Commonwealth ofMassochusetts Department oflndlustrial-A-ccidents X Congress Street,Suite 100 'R Boston,MM 02114-2017 www mass.gov/dia ,�. Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUT)IOPJTY- Applicant Information Please Print Legib Name (Business/Organization/lriidddiividual): S c Atwa -Address: A® 14"\ �� City/State/Zip: N.VQ',AC1l Phone#: O 60 ^ b`fit® A.r•eyon an employer?Checktlie appropriate box: Type of project(required): 1.1 4 Tim a employer with_S—, employees(full and/or part-time).* 7. Q New construction 2.[J 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.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself[No workers'comp..insurance required.]i 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. l will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repair's 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.# 6.Q We area corporation and its ofiicers.have exercised their right of exemption per MGL c. 14.D'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 subrriif khis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors jhat 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,`ally rnust provide their workers'comp.policy number. -Tam' an employer•that is pi•ovidii tg ivorlceis'compensation insurance fox•my employees.'Eeloiv is the policy and)ob site information. Insurance Company Name: � �� v1 Policy#or Self-ins,Lie.#: lG�sk��u�LA 1 b Expiration Date: Job Site Address: 1 �V "' "� �� City/State/Zip: 0 v ti C�b�Pv Attach a copy of the workers' compensation p olicy 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 verificatio T do hereby ce un er th pair2 an nal 'e ofper ury that the information provided above is true and correct. Si nature: �✓✓ Date: { Phone#• V J Official use only. Do not ii rite in this area,to he 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#: AC"R" 74'/19/2016 CERTIFICATE F LIABILITY INSURANCE E(MMIDD/YYYY) 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(les)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 tq the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: A 6 K Fowler Insurance PAHO No Ext: (978)664-0366 NC No: (978)664-2209 200 Park St. E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 North Reading MA 01864 INSURERA-.Western World Insurance INSURED INSURERB-Merchants Mutual Baystate Roofers Inc. INSURERc:ACE American Insurance Com an P.O. Box 189 INSURER D: INSURER E: North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1641311868 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 ADD L SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE PO C UMBE MID NYYY MMIDD YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE [A] PREMISOCCUR DAMAGE ES TO Ea occRENTEDurrence $ 50,000 NPP1403846 6/15/2015 6/15/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO ❑LOC 1,000,000 JECT PRODUCTS $ OTHER: $ AUTOMOBILE LIABILITY POaMaBINEDitSINGLE LIMIT $ 1,000,000. ciderl B ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX AUTOS SCHEDULED AUTOS MCA7015534 6/15/2015 6/15/2016 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LlAelLIrY YIN STATllT! ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA A C (Mandatory in NH) 6S62UB4609P06216 4/12/2016 4/12/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.,Additional.Remarks Schedule,may be attached if more space is required) Insurance verification - Please refer to actual policy for all other terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BayState Roofers, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 189 ACCORDANCE WITH THE POLICY PROVISIONS. North Reading, MA 01864 AUTHORIZED REPRESENTATIVE Nicole Orlanzo/NMO ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201a01) Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099895 : Construction Supervisor Specialtyy ROBERT E OKEEFE 21 FRANCIS STREET � - NORTH READING MA 01864 " ( - l� Expiration: Commissioner 09/29/2017 ' � �>lze �anr��za�nurea,Cl� a�./ll W�aucf� Office of Consumer Affairs&Business Regulati 'PHOMIMPROVEMENT CONTRACTOR Registration: 137193 E Expiration: 10/15/201.6 Supp BAY STATE ROOFER INC., ROBERT O'KEEFE PO BOX 189 N. READING, MA 01864 Undersecretar i. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099895 Construction Supervisor Specialty ��: ROBERT E OKEEFE 21 FRANCIS STREET NORTH READING MA 01864;- I Expiration: Commissioner 09/29/2017 ✓�ae �oow»w�zuseal a��i'aavacl c Office of Consumer Affairs&Business Regulati _HOME IMPROVEMENT CONTRACTOR Registration: 137193 Expiration: 10/15/2016 Supp 4 BAY STATE ROOFER INC. ROBERT O'KEEFE PO BOX 189 N. READING, MA 01864 Undersecretar r a