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HomeMy WebLinkAboutBuilding Permit # 6/2/2016 BUILDING PERMIT t%ORTI� TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION IL 0 111,11, 1 w-'.C Permit No#: )-h Date Received . r.0 .) CHU Date Issued: (0 7d I-p- L IMPORTANT: Applicant must complete all items on this page -2 4r-� ��-A- LOCATION . t PROPERTY OWNER A­y '3\1'\ ­(- ) Print Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building Wane family ri Addition E Two or more family El Industrial El Alteration No. of units: El Commercial 0 Repair, replacement n Assessory Bldg [I Others: [I Demolition El Other id� . 6 " 6d p Waf "M "'S r1 "'A "Dw DESCRIPTION OF WORK TO BE PERFORMED: /\,1denfifica Please Type or Print Clearly OWNER: Name: '0VA Q V,\ Phone: "2 Address: ' (11\ VIA, PV-Q IF Contractor Name: Phone: I,, o 6 Email: -777 Address: -7-77-F 2, �Vkc) P C Supervisor's Construction License: " Exp. Date: Home Improvement License: —Exp. Date: 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. -?)(b, — Total Project Cost: $ — FEE: $ Check No.: @ � Receipt No.: - q-(fA D NOTE: Persons contracting with unregistered contractors do not haveyacces t th guaranty fu' I ZVI SW attire of,Aqentlpwn�r .. Signature-of Contra or t%ORT'H Town of Andover ® _ o : LAKQ h ver', SSS, J 2 . IP COC111CNl wo[x y1' �P�,c�(� 11 BOARD OF HEALTH Food/Kitchen PERM T LD Septic System THIS CERTIFIES THAT . . .... BUILDING INSPECTOR .......................... .... ......... ... . ...................................... . has permission to erect .......................... buildings on ... .... ...... .... ..... .... ....... . . ... .. .....®............ Foundation ® Rough to be occupied as ...540.1 ...... ..... ... ............ .....................................:..................................... 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 CONSTRUCT ST Rough - .........,.. Service ....... ..... . . .. .G, ,,,rr.:. ............ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall ToBe one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Baystate Roofers, Inc. Proposal P.O. Box 189 North Reading,MA 01864 Tel . 978-664-0668 Date Estimate# Fax 978-664-4333 2/11/2016 15801 Name./Address IIIC# 137193 Arron Allen CSSL# 99895 30 Wright Street North Andover,MA 01845 Bay State Roofers I.nc proposes. Remove approximately 3100 square feet of the existing asphalt shingle roof down to the wood decking. Install new ice and water shield along the 6'roof edge, valleys and around all the roof penetrations. Install new 151b felt paper throughout roof area. Install new white aluminum drip edge along the roof perimeter. A new Lifetime GAF Architectural asphalt shingle will be installed over the prepared substrate. A new ridge vent will be installed to ensure the proper roof ventilation. All roof penetrations and flashing will be installed according to manufacturers recommendation, specification and details. Install new pipe flanges. Bay State Roofers will properly dispose of all roof debris in our own waste containers. Any wood decking that needs replacement will be an additional $2.50 per lineal foot. A new rubber.roof system will be installed on the back porch roof for an additional $2750.00 New Shingle Roof Remove 2 rows of wooden shingles to flash in new rubber system and cover with 1x8 azek after the roof is complete. Authorized Signature: Total $11,310.00 Waste containers supplied by Bay State Roofers, Inc. are for sole purpose of roof debris. Under no circumstance is the homeowner to use these containers for personal use. 10 Year Workmanship Warranty on all roofs. (Except Repair lobs) . CONTRACT ACCEPTANCE The specifications,prices,payment schedule are satisfactory and hereby accepted. Date: 5- 7— BAY STATE ROOFERS,INC.is authorized to perform work as specified. Payment will be made as previously outlined. Signature Ali bilis over 30 days are subject to 1 1/2%finance charge per month(18°10 Color annual). '."_�o{ � ; The Commonwealth ofHassgchaseity r Department qfndusirial ceidents Kd X Congress Street,Saite 100 ' Boston,.IMS.0?114-2017 www.rnass.goclia Workers'Compensation Insurance Affidavit:Builders/Contxactoxs/Electaicians/Plumbers. TO B)G, FffE,D WITH TfIE PERMlTTJNG A.UTROMTY. A licantlnformation Please Print Legibly Name (Iiiisiness/organizatlon/hidividlral): Ltx Address: City/Mate%Zz :_ _ Phone#: Areyou an employer?Checktfie appropriate box-., Type of:project(l gq'Wred): 1. I am a ernployez with_„, employees(full and/or part-timo).* 7. El New Corso action 2. I am a sole proprietor or partnership and have no employees wonting for me in 8. 0 Reroodelirig any capacity.[No workers'comp.insurance required] 9. Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp..insurance required..]t ❑ 10 Building addition 4.F-1I am a homeowner and will be luring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole II.E]Electrical repairs or additions prop rietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6Q We are a corporat;on and its officers have exercised their right of exemption per MGI,c. 14.0 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 subrtiif#his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t'Contractozs that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have -eraployees. ithe sub-con`tracto'rs have employees,they must provide their workers'comp.policy number.' Iai�t an employer that is providing ivorliers'compensation insurance for my employees.'Peloty is the�olicy all d job site information. fnsurance Company Name: Policy#or Self-ins,Lie.#: r Expiration Date: Job Site Address: City/State/Zip: Attach a cope of the Workers'compeirsat' rr 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 DlA for insiu•ance coverage verificatio Ido Hereby eer f U%;ude the ins a �)rn es ,perjury that the infor�in .1ionprovided above is true andcorrect. Signature” 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.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other.' Contact Person: Phone#: ® DATE.MM/DDlYYYY 4/.LSJzV.Lb 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 loos.(dot,Co>3(er ti�h s to•trig certificate holder in lieu of such endorsement(s). PRODUCER -CONTACT NAME: +.. •+ +..++,+ca. maaova.c,asvc A1C No EXt' ��/D)'OOY—1I JL7V A/C NO;Iy 1d)bb4-LLUy 200 Park St. E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# North Reading MA 01864 INSURER A:Western World Insurance INSURED INSURER a Merchants ,Mutual Baystate Roofers Inc. JNSURER C:ACE American Insurance Gom n P.O. BOX 189 INSURER D: INSURER E: f 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 ADDL S BR POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD YY)t IMMIDDlyyyyl LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00, A CLAIMS-MADE FxI OCCUR DAMAGE TO REN TEJ) 50 PREMISES Ea occurrence $ ivrrlvvsb�b b/i5/eus5 b/7b!"LU16 MED EXP(Any one person) $ D r UU) PERSONAL&ADV INJURY $ 1,000,00, GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00� X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGE LIMIT Ea accidentl $ 1,000,001 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED b BODILY�` AUTOS MGR7015534 6J15/2015 fi/15/2010DILY INJURY(Per accident) u HIRED AUTOS ^ AUTOS n Per accdentV �� 3 UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIM. IdS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LfABILITY Y I N ST 7D E E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s 1 000 OFFICER/MEMBEREXCLUDED? NIA C OOi (Mandatory in NH)_ 6S62UB4609P0621fi 4/12/2016 4/12/201'7 E.L.1 11 DISEASE-EA EMPLOYE $ 1,000,001 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 1$ 1,000,001 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,.Additional Remarks Schedule,maybe 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 Readina. PASA 01864 AUTHORIZED REPRESENTATIVE Nicole Orlanzo/NMO A-1 ©1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099895 .Construction Supervisor Specialty ROBERT E OKEEFE 21 FRAKIrZ1R RTRFFt J : NUH I M HFADING MA 019A& ,�=/►l^^� Expiration: Commissioner 09/29/2017 �ie �anr�na�aurea� o�✓�aac�i+.�eel7a s Office of Consumer Affairs&Business Regulation I OME IMPROVEMENT CONTRACTOR i PRegistration.' V171 q3 TvnP- Lxplration- 10111201E Supplement l is BAY STATE ROOEERINC. ROBERT O'KEEPE PO BOX 189 N. READING,MA 01864" J Undersecretary