HomeMy WebLinkAboutBuilding Permit # 6/1/2016 BUILDING PERMIT ® t%ORTH qp" t.[LED TOWN OF NORTHA VER APPLICATION FOR PLAN EXAMINATION ® _ Permit No#: A) � _ ��' Date Received AERATED PPPy(y caausti� Date Issued: IMPORTANT: Applicant/�must complete all items on this page LOCATION AJ( �� ,rent PROPERTY OWNER � f� � .r ) Print 100 Year Structure yes no MAP ; A PARCEL: � ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building e family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �rFCoodp fain r ;❑frWetland's `r '❑ 11Ua"tershed`Distrrct y, •x e. :G, / rr.r/' f:., Mj/ Il / :. _ tiA✓.- r. „Fh 1h�1 :.�?.3,±, rr-�.r ,. ?..-e'.Ft ✓ -. r'.r .,.�; ru,.„ r/ r ..`rr ��,r',', r � , .F ,� ',<;,, r 5,..,.5 n"r�re.,.: r:...,r. ,.,:.<r,.. /:,. vrf. !; ,/>I`. :�.r,' r �:. e, is.✓:. r .lr:v r..Y.a.�y r' `J „^ �.�;-:r .fN r l: /J .'` I..-allY:: r..s I ..,<, � ,t.^', x .f���1 .�, 6� //r.�..r,�'r ¢�i`. fs r ;r:r r k,.ff. ar,"�. �i 6 X�: ✓fA rel -� a5t c��.r"' ,r*. ,;t d :fi e... 1�� ,.� �� ' r� re l; xf✓ .9 .s.,,.r�,lFc r?r� � �.� �I' .., vfA ,��,�'rrf�. s.h r,!,.rr r t �� p WaterlSewe� ,�, ,� I l r�r� � ��a���� mfr, ar �✓,�r<,� 1. ��,t i�, .�,�: f�r,<�r,��� �,,,f� � _, ��,. f�� � �,;., f ,.,�,. �, DESCRIPTION OF WORK TO BE PERFORMED: t r 1 1 x-10 o - P+— cf <`) i ar-j, I c s . LL's, ��' c Identification- Please Type or Print Clearly OWNER: Name: 1C,� �Y�C �,t��r ��� Phone: Address: , "P,fl Contractor Name: T(4 I'\JQ-'Phone: Email Address:1°4 tAo d,-L1 , -' ` y i 1 1 Supervisor's Construction License: 6'tQ4,c` t, Alt Exp. Date: Home Improvement License: �r rc (43� ") CT Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �, o0 - FEE: $ / �, Check No.: __ Receipt No.: � � �15 NOTE: Persons contracting with unregistered contractors do not have access t the guar nt n - — i tkORTH Town ofrAndover L oo Mliabiwb; t-" ® 4 _ - ® OAKS �'eY° SSS' ' b COCKICM@WICK �• .90 RATE® U BOARD OF HEALTH Food/Kitchen PERM -IT T LD Septic System THIS CERTIFIES THAT ............ ........ .�..G::.:�.r�:"......................................................... BUILDING INSPECTOR has permission to erect s on g.... buildings /' � s' S Foundation ........................................................................ / Rough to he occupied as ......:U /,l r'... .....Yi.�:.(: .4. ............ ...... .,1`..::�::.'d ................. .. ............. 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ' Service ............ .......�U ..��................. ............ 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 Lathing r Dry Wall ToBe one FIRE DEPARTMENT Until Inspected and Approved ,t a Building Inspector. Burner Street No. Smoke Det. C, �/- We are fully insured 4 Evergreen Lae and licensed. Hopedale, MA 01747 { S,nCe Email: info@lctroofing.com '�; y` = 2 �w w.ictroofing.com TOLL FREE: 1-877-211-0212 MEMBER - -- OFFICE: 508-488-6639 D0) CT-HIC 0628724 MA-HIC 166876 08-488-6640 RI - HIC 35948 FAX. 5 �`�.� Quality Products + Quality Installations = Complete Satisfaction 7707 O SUB ITTED TO / HO HONE: DATE: STREET' CELL PHONE: EMAIL: c 1 CITIVTATEAND_ZIPCODE ? REES PRENTATIVE: k' CELL We hereby submit specifications and estimates for. Strip main home down to bare boardstplywood. Project measures sq feet f ti Replace rotten boards/plywood @ 1.50 per sq ft.($50.per sheet of plywood if needed) New roof system to consist of �� xvl -6 feet of High Temp/High Tack ice and water barrier with full fascia wrapapplied to all a ves andvalle�s'ras well as around a7 rl'oof protrusions (skylights,vent pipes,chimneys,step flashing).O -Diamond Deck High performance undedayment to be applied to remaining roof deck surface. ' -8"h:etal Drip edge installed on all eaves and rakes to allow for proper water diversion into existing gutters JW Apply.40 years CertainTeed Landmark Pro®Shingle in one color of choice.Lifetime warranty. c� �� -Apply 60 years CertainTeed Landmark Premium®Shingle in one color of choice for an additional$ '.Lifetime warranty. Y -Install CertainTeed vent to entire length of ridge. -Replace fishing on Chimney and seal all flashing with Geoce112300 Roofing sealant s . 1 Ridge with matching Hi and Ridge shingle accessory ca from CertainTeed -Cap g 9 P 9 9 rY P .. All gash will be removed via on site dumpster(s).Ground will be fully cleaned and left in same condition as when we arrive. ; 15 IT Watertight guarantee offered by LCT Lifetime CertalnTeed ShingleMaster warranty with SureStart Protection"fully transferrable applies to the entire CertainTeed Integrity Roofing System®C. tl �QrIlg ® tJ� _ g g�_ n.�^g- C rU D71" by to fumish matenal an Tabor -complete in ccordanpe with abov"5specifications,for_the the sum of dollars _. al [sit - Csy - nr ($Payment to be made as follows71 ,.. -5 "NOTICE TO OWNER" (/ Under the Mechanics'Lien Law,any contractor,subcontractor,laborer,materialman,or other person who helps to improve your pro and is not:paid for his tabor, erwces or, material,has a right to enforce his claim against your property. i against such claims b filing,before commencing such work of improvement,an original contra for the work of improvement of Under the law,you may protect yourself g y g, 9 modification thereof,in the office of the county recorder of the county where the property is situated and requiring that a contractors payment bond be recorded in such office. Said bond shall be in an amount not less than fifty percent(50%)of the contract price and shall,in addition to any condiYD for the performance of the contract,b conditioned for the payment in full of the claims of all persons furnishing labor,services,equipment or materials for the work des cn ed in aid con6ct �.� Authorized Signature 41 ZlCCepta?nce Of propogal -The above prices,specifications Note this proposal may be withdrawn " and conditions are satisfactory and are hereby accepted.You are authorized to do by us if not acceptedwithin days the work as specified.Payment will be made as outlined above. N Owner Signatur Y,6 (u�� ,J0 Date of Acceptance 111��1�' owner Signature j Air- Tire Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AL4 02111 wwtv.mass.gofldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �y Please Print Letiibly Name (Business/Organization/lndividual): ( } �/r t l ���J Inc Address: ( 61 S City/State/Zip; O*e_d,,l ej 6 ?�7 Phone#: Jnr'` g y S- to 0 l Are you an employer?Check the appropriate box: Type of project(required): I.N_1 am a employer with- -.�_.- 4- ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance, q_ ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.fZ Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp. insurance required.] — "Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy infuriation. t 1 lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1conrractors that check this box must attached an additional sheet showing the name of the sub-contracturs and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Selr-ins.Lic.#: 'MA �� Expiration Dater IT Job Site Address: V p � t�5 �ity/State/Zip:_ i V wA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cey c r t1 ins and p,�cnalties of perjury that the information provided above is true and correct. Si nature: / Date: a 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#: A�RZ> CERTIFICATE OF LIABILITY INSURANCE 9120 6) 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 to the Cert)ficate holder in lieu of such endorsement(s). PRODUCER NA CONTACT House ME PHONE (508)485-1926 aC No).(508)485-8519 STEPHEN A GERSH INSURANCE C o E-MAIL 9 Monument AVE ADDRESS: INSURER AFFORDING COVERAGE NAIC# Marlborough MA 01752 INSURERANorthland Insurance INSURED INSURERB: Let Construction & Service INSURER C: 144 Hopedale St 1NSURERD: INSURER E Hopedale MA 01747 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1612101488 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_ R ADDL UBR POLICYEFF POLICYEXP LIMITS INS LTR TYPEOFINSURANCE D POLICY NUMBER MMID D RENCE S 1,000,000 $1 COMMERCIAL GENERAL LIABILITY EACH OCCUR DAMAGE TO REMF� 100,000 A CLAIMS-MADE WOCCUR PREMISES Eaoaxatence $ X WS260087 10/11/2015 10/11/2016 NED EXP(Any one Person) 5 5,000 1 1 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 X j POLICY jEa LOC Employee Benefits $ OTHER: I : COMBINED SINGLE LIMIT 'AUTOMOBILE LIABILITY Ea accident b BODILY INJURY(Per person) $ ANY AUTO '... ALL OWNED SCHEDULED 1 BODILY INJURY(Per accident) 5 AUTOS AUTOS PROPERTY DAMAGE NON-OWNED Per accident 5 i HIRED AUTOS AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ '.. EXCESS LtAB CLAIMS-MADE I AGGREGATE 5 '.,..,...,, DED RETENTIONS PER $ OTH- WORKERS COMPENSATION STATUTE ER _ AND EMPLOYERS'LIABILITY Y I N EL EACH ACCIDENT ANY pROPRIEfORIPARTNERIEXECUTIVE - 5 OFFICER/MEMBER EXCLUDFIYIE n ( (Mandatory in NH) i L DISEASE-EA EMPLOY S dyes,describe under E.L.DISEASE-POLICY UMrr S DESCRIPTION OF OPERATIONS below NIA I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Fred Falcone Roofing and Property Services LLC is listed as an additional insured with respects to general liability. 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 REPRESENTATIVE Colleen Power/GERSH tGi!.tom — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 19014011 -4RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MtNDDlYYY!) 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 endomement(s). PRODUCER NAW' KarineAragao FAX STEPHEN W. GERSH INSURANCE AGENCY PHONE Exl: (508)485-1926 AIC, No: A : karagao@gershinsurancL-.com 9 MONUMENT AVENUE INSU S AFFORDING COVERAGE NAIL# MARLBOROUGH MA 01752 tNSURERA: ACADIA INS CO 31325 INSURED INSURERS LCT CONSTRUCTION &SERVICES INC INSURERC: INSURERD: 144 HOPEDALE STREET INSURER E: HOPEDALE MA 01747 INSURERF: COVERAGES CERTIFICATE NUMBER: 44832 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. 'NSR TYPEOFWSURANCE ADD SUB PODCYNUMBER M pCYEFF POLICY EXP LIMA LTR COIMMERCIALGENERALUABILITY EACH OCCURRENCE s k DAMAGE TO 0 OCCUR PREMISES RENTED PREMISES occtrnence 5 MED EXP(Any one person) S NEA PERSONAL BADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY❑JECT LOC PRODUCTS-COMP/OPAGG S $ OTHER: AUTOMOBtLEL1ABILI Y (Ea accident) c NEDtSINGLE LIMrr S BODILY INJURY(Per person) S ANY AUTO ALL OWN SCHEDULED N/A BODILY INJURY(Peraccident) S AUTOS I NON-OWNED PROPERTY DAMAGE S HIREDAZi, I AUTOS Per accident 5 I UMBREtLALIAB !OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE N/A ( AGGREGATE S DED I RETENTIONS S wORKERSCOMPENSATION X EATUTE ER --- AND EMPLOYERS'LIABILITY Y I N ANYPROPRIErORIPARTNERIEXECUnVE EL EACH ACCIDENT 5 100,000 A OFFICERIMEMBEREXCWDED? NIA NIA NJA MAARP301081 03126/2016 03/26/2017 (Mandatory in NH) EL DISEASE-EA EMPLOYEES 100,000 If yes,descnlm under E.L DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS below '... j N/A f DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it 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 mwr_mass.gov/twdhvorkers-compensation/iinvestigationsi. 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. AUTHO RSD REPRESENTATIVE A Daniel M.CrDyey,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 y'ey ✓- .� fi d. SY� Cyi V �F�'�JvfJL � Office of Consumer Afft&s aad Business P elation Farb Plaza- Sure 5170 =' Boston,Massachusetts 02116 Home Imgr.,ement Contractor Registration - Registration: 166876 Type: Corporaiion E(pi[aton. 711612016 Tri 254673 LCT CONSTRUCTION & SERVICES;.ING-- _ SARA GASTRO 144 HOPUALE 5T - HOPEDALE, MA 01747 __-- Update Address and refnra card_Mark reason for change. Address F— Renewal i E.pi yment ; Lost Card CS-1.^,Tf53 DEREK R-INGUETTE 132 T-VT}= AIDNOCK STREET Gardner MA 01440