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HomeMy WebLinkAboutBuilding Permit # 5/25/2016 %A RT#I! BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit Nod: Date Received A Sai C 8iu5 Date Issued: I " IMS Applicant must complete all items on this page LOCATION le"') 6Pe,,kS')-3-X)Q () Print o PROPERTY OWNER (4 I K0 Print 100 Year Structure yes 11 MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building El One family 0 Industrial El Addition F-1 Two or more family [I Alteration No. of units: [I commercial El Repair, replacement ri Assessory Bldg ri Others: [I Demolition Li Other DESCRIPTION OF WI RK TO BE PERFORMED: Tp --- Ve. Identification- Please Type or Print Clearly OWNER: Name: Phone:(,! r)- Address: Contractor Name: '7sav,4 c 'RIS` Phone: C Email: Address: Supervisor's Construction License: LJ —Exp. Date: Home improvement License: 00X Exp. Date:-,'�-'"" ARCHITECT/ENGINEER Phone: Address: .."""'Reg. No FEE SCHEDULE. BULD/kG PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. "z Le 2 (."2 11,�"') Total Project Cost: $ FEE: $ Check No.: t -2, c) Receipt No.: NOTE: Persons contracting with unregistered contra s(10 not av cces e guaranty fund IA®RTH Town of1Andover No.- 3q co� WIWI-�- . .4 25 2614 ® LAK. ` ver, Mass, COC KICN.WtCK °SAVE® ll BOARD OF HEALTH Food/Kitchen Septic System ' THIS CERTIFIES THATBUILDING INSPECTOR ............... ...... . .. ......C4;61............................... .................... ....... 10% ago Foundation has permission to erect ....... ................. buildings on . ...... . ............ ...... . ..... .... ...... . . Rough !!;iito be occupied as ........... ...... ........... .......... ......... ... .................................................................... Chimney provided that the person accepting his 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 UNLESS RTS Rough Service ..................... ... ............ ........ .��..:::.................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Co is us Place on the Premises — Do Not Remove Final No Lathing r all TBe One FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. iirr 62 High Street Everett, MA 02149 (617)-389-5611 License # CS-083324 Reg. # 182002 Job Site: Kyle Cataldo 270 Brentwood Cir North Andover, MA Terms: Estimate for strip and re-roof. 1. Strip entire roof down to wood decking. 2. Re-nail all roof boards as needed. 3. Replace all rotted roof boards as needed, up to 100 lineal feet is included in contract price any additional footage will be additional charge of$2.50 per foot. 4. Provide and install six feet of ice and water shield. 5. Provide and install 8-inch aluminum drip edge around entire perimeter. 6. Provide and install new synthetic roofing underlayment paper per code. 7. Provide and install new pipe boots. 8. Provide and install new ridge vent. 9. All flashing of chimneys,vents, and walls to.comply with roof system. 10. Provide and install new lifetime architectural shingles. 11. Remove all lead flashing around chimney.and provide and install new. 12. Pull all necessary permits. 13. Clean up and remove all job related debris. For the total amount of: $19,400. Contractor's signature: ! v �Uv-� IN The Commonwealth oflMassachusetts Department oflndastriaZ Accidents I Congress Street,,quite 100 Boston,MA 02114-2017 www.mass.gov/dza Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY Atoplicant Information Please Paint Legiibly Name(Business/Organization/Iiidividual): L P, (q Addxess: C_-,_'))_ k IP LA City/State/Zip: Phone Areyou an em foyer?Checlrttie a�proprlafe box: Type of project()equired: 1 am a employer with employees(fall and/or part-time).* 7. Now construction 2.[]1 am a sole proprietor or partnership and have no employees working for me in 8. Remodelitig any capacity.[No workers'comp.insurance required.] 3.[]!am a homeowner doing all work myself;[No workers'comp..insurance required.]t 9 Demolition 10 n Building addition 4.E:]I am a homeowner and will be hiring contractors to conduct all work on my property. 1-will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions pi6oietors with no employees. F 12.[JPlumbing repairs or additions 5. I am a general contractor anal I have hired the sub-contractors listed on the attached sheet. ❑ 13. oofrepairs These sub-contractors have employees and have workers'comp,instuance.t 6.E]We are a corporation and its officers have exercised theirright of exemption perMGL c. 14.❑Other 152,§1(4),and we have no,employees.(No workerscomp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing theirworkers'compensationpolicy information• Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must s4bmit a new affidavit indicating such. Contractors 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. Ifthe sub-contractors have employees,they riuA provide their workeis'camp.policy number.' I air'an employer tfiat is pi'ovidirig ivorrters'compensation insurance for'my employees.'.Below is the policy and job site information. '`7� Insurance Company Name: Cl CEJ Policy#or Self-ins,Lic.#: _ TNv_ ()( ��S. ExpirationDate: fir` U) / Job Site Address: ��� � ty City/State/Zip: ( '`s Attach a copy-of the workers'e'ompeligation 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 Eno 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 ce f j"m pains andpenalties ofpe'jar �thht the information provided above iS true and correct. Date S G Ph Official use only. Do not write in this area,to be completed by city or town offrcial. 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#: DATE(MM/DDIYYYY) AC®R" CERTIFICATE T OF INSURANCE5/10/16 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. to IMPORTANT: If the certificate holder is an ADDITIONALNSURED I , the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject h 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). CONTACT PRODUCER NAME: Sabatino Insurance Agency PHONE (617) 387-7466 FAX No; (617) 381-9186 564 Broadway E-MAIL ADDRESS: Everett, MA 02149 INSURE S AFFORDING COVERAGE NAIC# INSURERA:PENN AMERICA INS CO INSURED INSURERS: Safet Insurance Dipierro & Sons Corp INSURER C:American Zurich 62 High Street INSURER D: Everett, MA 02149 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 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. LTR ADDL 7��POIUCY 75/147/16 POUCY EXP LIMITS TYPE OF INSURANCE SRNUMBERMM/DDIYYWGENERAL LIABILITY 526 5/14/17 EACH OCCURRENCE $ 1 ,000,000 A DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Eaoccu a ce $ 100.000 CLAIMS-MADE OCCUR MED EXP(Ary one person) $ 5,000 PERSONAL&ADV INJURY $ 1 ,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER POLICY PRO LOC /16 2/25/17 COMBINED SINGLE LIMIT 2/25 B AUTOMOBILE LIABILITY 6232564 Ea accident $ BODILY INJURY(Per person) $ 100,000 ANY AUTO ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ 300,000 AUTOS AUTOS PROPERTY DAMAGE $ 106--,-000 NON-OWNED Peraccident HIRED AUTOS _AUTOS $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WC STATU- OTH- C WORKERS COMPENSATION 6ZZUB-OG02960 5/14/16 5/14/17 AND EMPLOYERS'LIABILITYY/N . 00,000 ANY PROPRIETOR/PARTNER/EXECUTNE E.L.ELEACHACGDENi $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 (MyandatoryI NH) E.L.DISEASE-POLICY LIMIT $ 500,000 DES6RIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 107,Additional Remarks Schedule,if more space is regui red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED NTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: tJ�@ ((C971i1t r?•ll!(rCCllf�l�,C��°ClJ:7ClC�lIJC�J •, Office of consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Type: Registration: 182002 r Expiration: 5/18/2017 Corporation DIPIERRO&SONS CORP. CiRIACO DIPIERRO 51 SYCAMORE ST EVERETT,MA 02149 Undersecretary Massachusetts _Department of Public Safety Board of Building Regulations and St, , d rcl Construction SUPer i.sor License: CS-083324 JERRY C DIPIERRO 51'Sycamore Street Everett AM 0214§ r Expiration Commissioner 08/13/2016 i