HomeMy WebLinkAboutBuilding Permit # 5/25/2016 j
BUILDING PE �O R TH
IT �� "F.a ,
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#:
Date Received p°Hgreo q`>
Date Issued: `
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IM ORTAN Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑ Two or more family ❑ I °dustrial
❑Alteration No. of units: i Commercial
❑ Repair, replacement ❑Assessory Bldg C `Others:
❑ Demolition ❑ Other µ
❑ Septic' ❑Il1%ell 0 Floodplain a Wetlands ; d Watei lied Disfrict,,
V1/atei/Seriver
DESCRIPTION OF WORK TO DE PERFORMED:
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Identification- Please'Type or Print Clearly
OWNER: Name: Phone:
Address:
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Contractor Name: 1t 1'ha
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Address
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rn Impr �
avement License
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST�BASED ON$125.00 PER S.F.
Total Project Cast: $- FEE: $
Check Na.: � C Receipt No.: - 1
NOTE: Persons contracting w” unre istered contractors do not have access to the guaranty fund
Signature of A ent/Owner ,r . ....,
g Signature of contractor
ttORT Andover
' d
Town of
No. 112a5 '?t
L �,® dA- h ver, Mass,
COCHICHEWIC,
Cl %J
U BOARD OF HEALTH
PERMITT L D Food/Kitchen
Septic System
THIS CERTIFIES THATL4— BUILDING INSPECTOR
® Mee, ........... Foundation
has permission to erect .......................... buildings on ....... .... o... .... ... . .. ......
Rough
PMJ)
tobe occupied as ........... ...... .......................................................................................... Chimney
provided that the person accepting t s 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
MONTHSPERMIT EXPIRES IN 6 ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIOTARTS Rough
' '� Service
............� .... ,yc:......... .. . .:...... ........................... Final
BUILDING INSPECTOR
p GAS INSPECTOR
ccupanc-p Permit Required to Occupy uildin� Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
r all ToBeone FIRE DEPARTMENT
No Lathing
Until s ecte and Approvedy the Building Inspector. Burner
Street No.
Smoke Det.
EXPRESS ROOFING PROPOSAL DATE OF PROPOSAL: 512112016
BLIS14ED 1985 UPRESS ROOFING,
mike@expressroofer=m Quality You Can Lack Up Tao
P.O.Box 542,Chelmsford,MA 01824 vvww,exDressrooferxom
Phone:978-256-2333/Fax:978-251-2907 CONSTRUCTION SUPERVISOR LICENCE#99497
PROPOSAL SUBMITTED TO: ROOF COMP LETION DATE-
SALS PIZZA SQ
490 MAIN ST YEAR HOUSE BUILT
[NORTH ANDOVER — 108126
HOME IMPROVEMENT CONTRACTORS LICENSE
We hereby propose to furnish materials and perform the labor necessary for the completion of.,
STRIP ALL ASPHALT SHINGLES OFF ROOF CLEAN UP AND HAUL AWAY
TARP: OFF I HELP PREVENT TO HOUSE, PLADECKS,: VALK WAYS
LAWN AREA RE-NAL ROOFING BOARDS AS NEEDED WITH 4--
-D RING SHANK NAILS TO ENSURE SECURE BASE FOR NEW SHINGLES
ALL WALL FLASHING WILL BE—INSPECTED AND REPLACED AS REQUIRED
Install: Owens Cornin Weather Lock G Prograde 6' up from the bottom eaves
—5—wensCorninq Weather Lock(3 Pro rade under chimney lead and 3'down on roof
Owens Cornin,, Weather.Lack G Prograde in valleys .lights
Owens Corning weather Lock G Prograde around sky f
--Owens corr�i cl Weather Lock(3 Prograde around vent pipes o walls
Owens ornin Weather Lock G Pro rade on root where roof butts into
Rhino S nthetic Roofin Underlayment over roof boards
Owens Comin Starter stri on all roof deckinq edges
Owens Corning Duration Architectural shingles We install 6 nails er shingle for a 130 mph 0(;wind warranty)
Cut in 1 1/2" o enin on eak of root and install Roof Saver nage vent along all ridge surfaces (All,rid ge vent is Hand Nailed
Owens Corning ridge cap shingles
8"' Drip ed eon all outside root edges white)
New pipe flanges over vent pipes (2"-4")
All shin les will be fastened - 1 1/ 1 plated roofing nails
will using 1 14" 2"rooting nails electro
BLOW OFF ENTIRE lKI- ROOF AND CLEAN GUTTERS AND DOWNSPOUTS
ROLL 3 FOOT MAGNETS OUT 10 PICK NAILS OFF LAWN AREA FOR FINAL CLEANUP
INCLUDES:ALL LABOR AND MATERIALS FOR THE ABOVE
ALL ROOFING PERMITS ARE IN INCLUDED WILL BE RECYCLED AT ROOF TOP RECYCUNG
ALL ROOFING MATERIALS STRIPPED OFF YOUR ROOF
o
AND HAUL AWAY ALL SHINGLES
Note:No warranty on problems and/or damaged caused by ice backups No warranty on old skylights
All material is guaranteed to be as specified,and the work to be performed in accordance with the drawings and specifications
submitted for above work and completed in a substantial workmanlike manner for the sum of. $7,984.00
$ NO MONEY DOWN
PAY ENT IN FtILL AT COMPLETION OF JOB WITH CASH OR 13ANK CHECK
MADE OUT IN THE NAME OF Express Roofing INC.
Call Toll Free Respectfully submitted
40 drawn by us if not accepted by:
B
mw- 1-888-21 O-ROOF Note-This proposal maybe with 5/2012016
BB,
OEM All workers fully insured
ACCEPTANCE OF PROPOSAL
The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized
to do the work as specified.Payments will be made as outlined above.Any additional work than the above will be
an extra charge.
Signature
Date .51., SHINGLE COLOR
14o?'ne,o7;T,er is responsible for protecting and cleaning content of attic frontpossible dust and debris during your roofing project.
Not responsible for,any issues caused by snold
ANY ROOF BOARDS THAT NEED TO BE REPLACED WILL BE AN EXTRA CHARGE OF$4,00 PER BOARD FOOT
WE RECOMMEND NEW CHIMNEY LEAD WITH ALL NEW ROOFS FOR AN Ex'rRA CHARGE OF$595.00 EXTRA PER CHIMNEY
WE RECOMMEND TO REPLACE ALL OLD SKYLIGHTS WITH NEW VELUX SKYLIGHTS WITH ALL NEW ROOFS FOR AN EXTRA CHARGE
Any 112 In, Plywood Installation for roof will be an additional charge of$55,00 PER SHEET Labor and materials included
The Commonwealth of Massachusetts
Department of IndustrialAccidents
u Office of Investigations
` d I Congress Street, Suite 100
w
Boston, MA 02114-2017
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib
Name (Business/OrganizatioiVIndividual): ((V (�
Address: 01
City/State/Zip: Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.El am a employer with 4. am a general contractor and I
employees (full and/orpart-time).
* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ P bing repairs or additions
myself. o workers' com right of exemption per MGL
Y p 12. ' Roof repairs
insurance required.] f c. 152, §1(4),and we have no
employees. [No workers' 131-1 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit 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. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ant aii employer tliat is providing workers'coinpeitsation insurance for my eiiiployees. Below is the policy and job site j
information.
Insurance Company Name: ��7LFb(V�tIL _
Policy#or Self-ins. Lic. #: 2'b DI 7AL Expiration Date:
Job Site Address: 11/o <01 City/State/Zip: 0—
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 fine
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.
I do hereby certify under tl 'is and penalties of pei jury that the information provided�abboov is true and correct:
J J�
Signature: -� -®�"� Date:
Phone#: /6F dv� d�
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#:
SIC CERTIFICATE I 0izlYYI
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 INSUMER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is-an ADDITIONAL INSURED,the polleyjies)must be endorsed. If SUBROGATION IS WAIVED,subject to the
terns 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 CONANAME' �� ANORE SILVA
RAPD t&JEPSEN INSURANCE:SERVICES INC, NION .ExII, 508-�755�0 islC,tLaI 508 575 5865
191 CONCORD S7 !
ADDRr-E 'SS
DR ANDRECRAPUANDJEPSEN.COM
;
FRAMINGHAM MA 01702 INSURERASIAFFCRDIt GCOVERACE NAIC0
INSUREta A ENDURANCEINSURANCE,
INSURED 'INSURER n LIBERTY MUTUAL.FIRE INS CG
FIVE STAR GENERAL CONSTRUCTION CORP i
153 ARLINGTON ST APT 2 i INSURER C
F RAM INGHAM.MA 01702 INSURER I)
INSURER I_
COVERAGES CERTIFICATE NUMBER: _ _ REVISION NUMBER:
THIS JS TO CERTIFY THAT IHI- 1"OLIGtFS O INSURANCE LISTED 6ELCJW HAVE Gi_C"i I6,��L1EL1�TU THl? IN�t.tR6.iU NAMED Ahr�V@ FOR TWE. POLICY PFRIOC3
INDICATED NC)TWIT STANDIh z7 ANY REQUIREMENT TERM UIQ CONDITION OF ANY (;iA41RAGT OR OTHER DOCOMENT 0.1% RESPECT TOWHICH THIS
CERTIFICATE MAY 6E ISSuE7 O2 MAY f'F_RTAtN THE INSURANCE AFFORDED BY ?HC POLICIES 0FSC,R10FD 1+=RCIN IS SI)0JECT 'TCS ALL THF TERMS
EXCLUSIONS AND CONDITIONS�:3F•iOCH PCL.ICiES LIMITS SHi,VON M,AY NAVE BEEN RFOUCED BY PAID CLAflhls
INSR ADDL SUBR POLICY EFF POLICY EXP
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I k1Wy.:U0RKEPCC 1'U00.000
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PR0.4-SKS(Ea rtzmw'4i"A; s 100,000
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A CEC20001273700 0410612016 0410812017 .&,•r)v;�y,rj;a, S 1,000,000
tnCR6i.et< a, arc' s 2,000.000
$ 2,000.000
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DESCRIPTION OF OPEPWiONS,!LOCA tO eq r V011CLES(Atlas,,ACORP tut A.&,EAonAi+,Vivra v
a 1:
CERTIFICATE HOLDER CANCELLATION
MIC;HAF I_I.CORTNF:R S14OULD ANY OF THE ABOVE DESCRIBED POYIESCA CEL FORE
THE EXPIRATI®N DATE THEREOF, NOTIB I ED IN
16 JONAS RU ACCORDANCE WITH THE POLICY PROVISIONS ,,Be
WESTFORD MA —
AUTHOW.ED REPRESENTATIVE
MIKEOFXPRESSRt;OFER COM
it)9935-2010 ACOR PORATION, All rights reseihd.
ACORID 25(2010105) The ACORD name and logo are registered marks Of ACORD
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSSL-099497
E oast,°E.tcfi� r� SuraQrvi rjr Spr2c� aIty
MICHAEL L CORTNER
16 JONAS ROAD
WESTFORD MA 01886
CA— Expiration:
Commissioner 04/24/2018
Office of Consumer Affairs&Business Regulation
y� HOME IMPROVEMENT CONTRACTOR
I;Registration: 185252 Type:
Expiration: 5/16/2018 Corporation
EXPRESS ROOFING INC.
MICHAEL CORNTER
16 JONAS RD.
WESTFORD, MA 01886 Undersecretary