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HomeMy WebLinkAboutBuilding Permit # 6/9/2016 BUILDINGPERMIT k4 tl CSP NOR,rH ANDOVER APPLICATION FOR PLAN! EXAMINATION Permit NO. � �� u�, � �.����a Date Received Date IssuedI ,,, I11✓dPORTA e LOCATION PROPERTY C)WNERfs Print � Print IAP NO, �a � PAF (��L: ' ����� ZONING� C�I��F�I�h: 'Historic District frit=ye Machine Shap Village TYPE OF IMPROVEMENT PROPOSED USE Rosi ential Non- Residential -I New wilding One ne family I-1 Addition Two or more family I I Industrial Alteration No. of units: I Commercial I epair, replacement I I Assessory Bldg CI Others: I Demolition D Other I_.I Septic El Well Lrl Floodplain El Wetlands 1 Watershed District- E] Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: � `� ® n t c� Phone: � 1 Address: CONTRACTOR,TCR Name: Phone: Address; f , l7 3 " Supervisor's Construction License: � E p. Date: lone.IrrtprovementLicense: Earp. Date* ARCH ITDT/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. otal Project Cost: AOdd : ; Checlk No.: � l Receipt No .,.. OTE: Persons contracting with tinregistered c it actor (it)itot have aces,to e f qy fuiid N Signature of Agent/Cerner i nature of contractor e C,Town of ndover ver' Mass, p. cocN1'[HeW1 °�aTEIC c IJ BOARD OF HEALTH PERMIT T Food/Kitchen �— Septic System THIS CERTIFIES THAT ............... ......................................................... BUILDING INSPECTOR has permission to erect .......................... buildings on - ...,`„�, �, ,�..C� !�- Foundation to be occupied as ..... Rough . . . .......... ...�. .................................... .... .... . .. .. ......... .. pp... ........ Chimney provided that the person accep Ing this permit shall in every respect conform.. ..to t.h.e terms. . of the. ...a. Iicatio.. n on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSrJTION Rough Service BUILDIN NSP. T®R. Final GAS INSPECTOR ccupancy Permit Required t® Occuov By Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. RA CARLO ROOFING .COM Home Construction Lie. Cs02O350 R.A.Carlo Com ny 2a_ Vinyl Sidi ng*Roof#ng*Windows 65'Dunster Road Bedford, Massachusetts 01730 Phone (781) 275-7310 Fax (781) 275-9775 Proposal Submitted To:/ atm MR JAMES WHIFFEN 5/13/15 Address 39 WEYLAND CII NORFH ANDOVER MA Phone 61.7-909-7000 Contact We hereby submit specifications and estimates for: Strip existing roof Install TITANIUM UNDERLAYMENT Install new metal dripedge. Install new ventcollar flashing and new flashing in chimney. INSTALL R11)(Y'EVENT ALONG ]PEAK OF ROOF Install ice and water shield along roof edges and in all valleys.6, Apply newCertainteed LANDMARK LIMITED LIFETIME asphalt-fiberglass self= sealing shingles to all roofing areas Cover house with tarps Clears and truck all debris away. Any rotted wood to be replaced at$3.75 a ft. RA CARLO BETTER.BUSINESS BUREAU ACCREDITED Ad-RATING LIMITED LIFE TIME Guarantee for Materials add 16 Year Guarantee for Labor We propose hereby to furnish inaterial and labor, complete in ac o d, ii e ith above specifications, for the sum of-_$10,000.00 Authorized Signature _ . _. Note: This proposal may be withdrawn by us if not.accepted within_____ d, Acceptance of Proposal: The above prices, specifications and conditi ns " -,,,sat' .' alctory and are hereby accepted. You are authorized to (to the work as specified. Payment a as outlined above, 1/3 at start of job balance upon completion Start Date— Completion Date-,-----. Customer and. RA Carlo will determine start date at, signing; of contract. PLEASE COVER. STOREDJ'HINGS IN ATTIC SOME DEBRIS MAY FALL IN The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: 7 AA-' t5 "(F=PC--`J P Location: CO2. Cit �lti &.0 Phone am a homeowner performing all work myself. F-1I am a sole proprietor and have no one working in any capacity am an employer providing workers'compensation for my employees working on this job. Company name: �. Address (�� ��y vt S T`77- City: 52City: e i L � _ ( �() Phone#: (o(2 92&0��-Z Insurance Co. Policy# i' 9-2 73 e.S' Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certifynd p 1 's of perjury that the information provided above is true and correct. Signature Date !v Print name OQi�sZl /� `/{�l.�tJ Phone# (¢C 2 Official use only do not write in this area to be completed by city or town official' ❑ Building Dept F-1 Check if immediate response is required Building Dept p Licensing Board O Selectman's Office Contact person: Phone#: n Health Department 1771 Other FORM WORKMAN'S COMPENSATION To: Page 3 of 4 08/06/2016 10:17:30 EST 16178128191 From: Adrienne Monks �+ DATE(MMIDDtYYYY) CERTIFICATE C������� �� OF LIABILITY INSURANCE 6/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY 'R NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURAN . 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 endorsement(s). PRODUCER CONTACT Anna Lukas NAME: T. Edmund Garrity & Co. , Inc. A/CONE Ext: (617)354-4640 A/C No:(617)359-5828 545 Concord Ave. E-MAIL annie@garrity—insurance.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC 6 Cambridge MA 02138 INSURER A:Endurance Insurance INSURED INSURER B RA Carlo Inc INSURER C: 65 Dunster Rd INSURER D INSURER E. Bedford MA 01730 INSURER F: COVERAGES CERTIFICATE NUMBERm. aster COI 2016 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. I NSR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMiDDIY YY LIMITS LTR x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 500,000 A CLAIMS-MADE I--]OCCUROCCUR DAMAGE ( RENTEDEaoccurrence S 100,000 PREMI CBC200o1177400 3/8/2016 3/8/2017 MED EXP(Anyone person) s 5,000 PERSONAL B ADV INJURY S 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 1,000,000 X PRO- 1,000 000 JECT POLICY LOC PRODUCTS-COMP/OP AGG 5 , OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULEDAUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Peraccident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAB HCLAIMS-MADE AGGREGATE S DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR'PARTNER+EXECUTIVE ❑ NIA EL EACH ACCIDENT S OFFICEWMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE_ 5 If yes,-describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LI/.SIT I S DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of N Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 384 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS, North Andover, MA 01845 AUTHORIZED REPRESENTATIVE W Garrity/SPORTi ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025rpmdml To: Page 4 of 4 08/06/2016 10:17:30 EST 1 61 781 281 91 From: Adrienne Monks ACC)1?®® DATE(MM/DDNYYY) . CERTIFICATE OF LIABILITY INSURANCEik� 06/08!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 endorsement(s). PRODUCER CONTACT NAME: annie lukas T. EDMUND GARRITY& CO., INC. A Nn Ext: (617)354-4640 (FAX. E-MAIL ADDRESS: annie@garrity-insurance.com 545 CONCORD AVENUE INSURERS AFFORDING COVERAGE NAiC ff CAMBRIDGE MA 02138 INSURER A! TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B; RA CARLO INC INSURER C: INSURER D; 65 DUNSTER RD INSURER E: BEDFORD MA 01730 INSURER F: COVERAGES CERTIFICATE NUMBER: 59484 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 TYPE OF INSURANCE ADDL SUOR POLICY EFF POLICY EXP LIMrrS LTR S POLICY NUMBER MMIDDNYYY MM/DDNYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DA�IAGE TO RENTED _ CLAIMS-MADE D OCCUR PRET"SES Ea occurrence) MED EXP(Any one person S NIA PERSONAL&ADV INJURY S GEN%AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY D PRO D LOC PRODUCTS-COMPIOP AGG S JECT __.._._�_....� OTHER- S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per perswi) S '.. ALL OWNED SCHEDULED N/A BODILY INJURY(Per accideal) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per .accider.il S UMBRELLA LIAB OCCUR EACH OCCURRENCE S '.. EXCESS UAB CLAWS-MADE NIA AGGREGATE S DED I I RETENTIONS ��// S WORKERS COMPENSATION /� STATUTE I EORH AND EMPLOYERS'LIABILITY -- -- ANYPROPRIETOR/PARTIJER/EXCCUTIVG — E.L.EACH ACCIDENT S 100,000 A OFFICERIMEMBEREXCLUDED? wA wA NIA 6HUB2E92734915 10/27/2015 10/27/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1_00,000 T It yes.describe under DESCRIPTION OF OPERATIONS beluw I IEL.DISEASE-POLIGY LlMlT S 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Romarks Schedule,may be allachad if more space is reyuired) 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 ww\,v.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover ACCORDANCE WITH THE POLICY PROVISIONS, 384 Osgood St AUTHORIZED REPRESENTATIVE r; Andover MA 01845 Daniel M.CroSv)'ey,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 v/ Vd2 ,0/)I Jt 07IweaS"P/✓ C(CJ9llC�CCSC '--:Office of Consumer Affairs&Business Regulation ;W IMPROVEMENT CONTRACTOR l�W— HOME Registration: 106052 Type: Expiration:_ 7/2112018 DBA R.A.CARLO CO Robert Carlo 65 Dunster Road Bedford,MA 01730 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-020350 Construction Supervisor ROBERT A CARLO 65 DUNSTER ROAD BEDFORD MA 01730 r'jZU7 l" Expiration: Commissioner 04/12/2018