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HomeMy WebLinkAboutBuilding Permit # 6/15/2016 `%ORTp-H BUILDING P RMITF.D 76�w TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ p Permit IVo#: Date Received RAYED �SSgcHUS Date Issued: J s r IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes J MAP PARCEL: ZONING DISTRICT: Historic District yeMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resi tial Non- Residential ❑ New Building &One family ❑Addition ❑ Two or more family ❑ Industrial ❑8Peration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other f r f Wej1 y f %❑❑SFlootl rlai'n ' Wetlands ' z% ,`❑ 1Natershed Dsfnct 'r, r=eptic. ❑ , (a'�'�.n"� ✓�saP:� ! fir' a f gid` 5 f�, Y� I G�r' r r�' �' .a! „k r.(s,.,; ,�r�r.,;,..,,. ., j r's"r.�r� � '.�` t 'a "2 / .� Yn / �` �f" r a.'(" ¢,fy,.l� l;rs,,r:vFi it a/�. -r� a S fxf y P r?•.�` I F:. is ,baa J vs. l ai4 If � ,� r .tri ,-'r✓ ra 5 a^s"�r f r ,'-: r� �r r ra ?'r.o t/f. J. s ❑�lUater/Sewer,,,�.x,.r ..�.r,,a,rJ rf��'/,yI',l z.%��i�7T��_9,�.1';;�r'f'���.'� �F, �„/ ;afar' a fli � ,.��aSv`r 1 �r + ;'a:.,,.., 'a r,a'a,`�. „l/tT DESCRIPTION OF WORK TO BE PERFORMED: denti igation- Please Typ or Print Clearly� OWNER: Name: Phdne. " Address: G Contractor Nam : � 6 � Phone` Email: Address: �- Supervisor's Construction License': � Exp, Date: Home Improvement License: Exp. Date: )-7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000. OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: � NOTE: Persons contracting with unregistered contractors do not haveiaccess to t1 uarant a 1d t%O tt py Town ofAndover o 2 ® w`• 0 ® a X11 ver, Mass,t COCKIC K@WICK V RATED p.e10 ,��� U BOARD OF HEALTH Food/Kitchen P E Septic System THIS CERTIFIES THAT ....... BUILDING INSPECTOR .............M !7 .. .......... ....................... .......................................... has permission to erect ............. buildings on .... 0, Foundation ............. ....... .. ..... .. .... .... ................. Rough tobe occupied as ............itf........ ..... .............................:..................................... Chimney provided that the person apermit 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 CONS , TIO Rough Service . . .... ........ ...... ............ Final B DING I PECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 'Ip Proposal HIC#174377 Jp D e ous e of:IM 'RoM g L'LP A trusted name since 1938 Roofing _ Siding -Windows 87 Belmont Street - North Andover, MA 01845 P. 978-683-4588 - F: 978-685-7446 NAME OF OWNER — ADRESS OF JOB TEL. Z?-' 49k DATE: We will remove all roof shingles off total roof area, layer. Replace any boards or sheathing at additional cost. A new 8" white aluminum drip edge applied on all edges. Approx. Eft of ice and water membrane applied on eaves, 3ft in valleys, strips around skylights, along chimney flashing and sidewall junctions. Existing step flashings to remain. A new base sheet applied. Architectural roof shingle installed with a limited lifetime warranty. Install new veotpipe boot flashin oof existing chimney flashing and remove debris. Shin gLe Calor: ' Z 25, Ridge Vent Upgrad 61 Wood Sheathing Repair$3.50 IQ, )CMd V0 We Propose herby to furnish material and labor-complete in accordance with above specifications,for the sum of: �Ila r s($ Payment to be,made as follows 14-31 Authorized Signature NOTE:This proposal may be withdrawn by us if not accept with in -�' ys Acceptance of PropoSal - The above prices, specifications and conditions are satisfactory and are herby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature mah A/L C I Date of Acceptance: Signature HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS(M.G.L.142A) 1.WORK:Provided the Homeowner performs under this agreement,the Contractor shall perform the work on the Property as specified Proposal,attached incorporated herein.The work does not include extraordinary conditions of which the Contractor could not reasonably be aware.If such conditions are encountered,this shall be an additional cost to the Homeowner.Materials selected by Homeowner may have to be ordered or custom made,which items are specified in the Proposal.The Contractor is not obligated to agree to any modifications,extras or change orders unless such items are agreed to in writing by the Contractor.All extras and changes shall be at an additional cost to the Homeowner.Contractor shall perform the work in a good and workmanlike manner using materials consistent with this contract.Lawn or Driveway may be damaged by dumpster or equipment. Due to material shortages Contractor may substitute materials of equivalent grade. 2. PERMITS:If a building permit is required for the work,the Contractor shall obtain same as Homeowner's agent.Contractor is not responsible for any other permits that may be required for the Work,and Homeowner is responsible to determine whether any zoning,planning or wetland related permits or approvals are necessary.Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund. 3. COMMENCEMENT AND COMPLETION:Homeowner acknowledges the commencement date of the work is fluid,and is subject to numerous factors such as scheduling other contractors,delivery of materials and weather.Contractor and Homeowner shall determine the commencement date of the Work when a more definite determination can be made and shall execute a written acknowledgment of same.The Work shall be substantially completed within 7 days of commencement,except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal,and subject to delays for circumstances beyond Contractor's control.Notwithstanding,the commencement date and substantial completion date may be extended,and the Contractor will not be liable for delays caused by,labor or material shortages,delays in delivery of items selected by the Homeowner,govemmental action, and unforeseen events beyond the Contractor's control,including but not limited to weather,strikes,war,the acts of third persons or the acts of the Homeowner.The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractor's other jobs. 4. PAYMENTS: Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the Proposal.Thirty percent(30%)of the total is to be paid as a deposit with the signing of this contract.Upon cancellation prior to commencement of the Work,any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel.Final payment shall be due upon completion of the Work and Homeowner agrees it may not hold any retainage.Late fees may be applied for late payments.Homeowner shall pay Contractor's reasonable costs of collection,including attorney's fees and costs.Time is of the essence hereof. 5. WARRANTY:For a period of 2 years after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship, but not those caused by ice backing-up or extraordinary weather events,including blizzards,tornadoes,hurricanes or storms of greater than a twenty-five year duration or intensity.Contractor gives no warranties with reference to any materials or equipment installed in the Premises,passes any such warranties directly to Homeowner,and Homeowner agrees to look only to the manufacturer with reference thereto.This limited warranty extends to the Homeowner only and is not transferable to succeeding Homeowners.This Limited Warranty specifically excludes(i)all consequential and incidental damages;(ii) damage due to ordinary wear and tear,abusive use,misuse,or lack of proper maintenance;(iii)defects which are the result of characteristics common to materials used;(iv)defects in items installed or supplied by anyone other than Contractor;(v)work done by anyone other than by Contractor;and(vi)loss or injury due to the elements.There are no other expressed or implied warranties or representations made or given. 6. ENTIRE AGREEMENT:This contract and all documents referenced herein constitute the complete and final agreement between the parties.In the event that any of the provisions of this contract shall be held to be invalid,the remainder of the provisions of this contract shall remain in full force and effect.Two identical copies of this contract have been completed and signed.Homeowner acknowledges receipt of a completed contract signed by the Contractor. 7. HOME IMPROVEMENT REGISTRATION:In accordance with M.G.L.c. 142 A,§9,Contractor is registered with the Bureau of Building Regulations and Standards Resistration No: 174377.Homeowner may verify by contacting the Director at(617)727-3200,ext.25205.A Homeowner's rights under the Home Improvement Law(M.G.L.c. 142A)and other consumer protection laws may not be waived in any way.Homeowner acknowledges receipt of a copy of 780 CMR R6 and Massachusetts General Laws chapter 142A,and which are available online at www.mass.gov.Questions may be directed to the Consumer Information Hotline,(617)727-7780. 8. ARBITRATION:Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has a dispute concerning this contact, the Contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 142A.No lien or security interest is imposed on the Property as a consequence of this contract,but Contractor has the right to record this contract or a notice of this contract,or seek a lien if the Homeowner breaches this Contract. 9. HOMEOWNER COVENANTS:The Homeowner agrees,represents and warrants that(a)the Homeowner grants permission to the Contractor to enter the Property to perform the work as covered by this contract;(b)the Homeowner has fiords available to make full payment under this contract to the Contractor upon completion; (c)the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition,and agrees not to enter portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed;(d)Contractor may need use landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and(e)that code requirements may result in roofing nails penetrating through roof decking and will be visible on the underside of some surfaces.The Homeowner indemnifies,exonerates and holds harmless the Contractor from any loss,damage,claim,liability or expense(including reasonable attorney's fees,deposition costs and court costs)resulting from a breach of this provision.Contractor is not responsible for damage to landscaping that will grow back during the next growing season. 10. CANCELLATION:Homeowner may cancel this agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not later than midnight of the third business day following the signing of this agreement. HOMEOWNER: DATE: Shingle: DEPOSIT:�� L The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Sheet f� Boston,PIA 02111 J, 1 w)v.mass gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busing /Organization/Individual): P b6 C..,Pz6-104 L,P- Address: �t5 v 7' City/State/Zip- / Phone#: Are yfib an employer? Check the a propriate box: Type of project(required): 1- 1 am a employer with • ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part e).* have hired the sub-contractors 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.? required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 31-11 am a homeowner doing all work officers have exercised their 11.❑Ph ing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. iarepairs insurance required.]; c. 152, §1(4),and we have no 13.❑ Other employees.[No workers comp.insurance required.] *Any applicant that checks box irk must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then lire outside contractors must submit n 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-contractor have employees,they must provide their workers'comp.policy number. I atzz an employe•titat is providing ivorlrei-s'coliipeiisatiolt iizsJlfaizee for n{y enzployees. Below is the policy and job site information. Insurance Company Name: Policy r orSelf--ins.Lic.r; > `" ' ! Expiration Date: 6' Job Site Address' City/State/Zi W Attach a copy of the workers'ca ensation 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 eerti uz r the paitzs aizd petialties of pez jztry that t/ze itz fozvtzation prot�itled above is trite and correct. Siutlature: liL�t Date: Phone14 : Ofrlcial use on1}. Do not write iu this area,to be completed by city or town offzciaL City or Town: Permit/License ft Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone m: C ® CERTIFICATE F LIABILITY INSURANCE DATE{04/118!20168/2016 Y, 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 certificate holder in lieu of such endorsement(s). CONT PRODUCER NAME:CT Diane LeBlanc DOHERTY INSURANCE AGENCY INC PAICHONE , (978)475-0260 c No A AMLESS: dleblanc@dohert insurance_com P.OBOX 1985 INSURER(S)AFFORDING COVERAGE NAIC0 ANDOVER MA 01810 INSURER A: AIM MUTUAL INS CO i 33758 INSURED INSURER S DAMPHOUSSE ROOFING LLP INSURERC: INSURER D: 87 BELMONT STREET INSURERE: NORTH ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 45466 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. O L R MMYEXP INSRLIMITS,TR TYPEOFINSURANCPOLIYNMMI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE D OCCUR PREMISES Me occunonce 5 MED EXP(Any are person) $ I N/A j PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE _$ POLICY PRO LOC I PRODUCTS-COMP/OP AGG 15 JECT 1 ROTHER: O S AUTOMOBILE LIABILITY Ea aBccidentSINGLEUMIT I$ ANY AUTO BODILY INJURY(Per person)—t S ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) $ AUTOS AUTOS -- NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Par accident) _ is UMBRELLALIAB .00CUR EACH OCCURRENCE S EXCESS LIAR 71CLAIMS-MAGE N/A 1AGGREGA7E _ S DED RETENTIONS v S WORKERS COMPENSATION /� STATUTE EORH AND EMPLOYERS'LIABILITY Y f N ANYPROPRIETOR/PARTNERIEXECUTIVE I E.L.EACH ACCIDENT _ S 500,000 A OFFICERWEMBEREXCLUDE07 NIA NIA NIA AWC40070287742016A 04/17/2016 04/17/2011 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 1I yes.dosuibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Romorka Schedule,may be attached If 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 www.mass.gov/lwdfworkers-compensationrinvestigations/. 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 Andover MA 01610 Daniel M.Cro n ey,CPCU,Vice President—Residual Market—WCRIBMA 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Client#: 14415 DAMPHOUSSE DATE CERTIFICATE I� LIABILITY I 04/1812016 YYY) N PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 198$ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Western World Damphousse Roofing LLP INSURER B: 87 Belmont St INSURER C North Andover, MA 01845 INSURER D: INSURER E: COVERAGES 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 CONTRACTOR 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTA NSR TYPE OF INSURANCE POLICY NUMBER TATE TEY EFFEOCTIYE OLICE(KINV ONY) LIMITS A GENERAL LIABILITY NPP8202847 04112/16 04/12117 EACH OCCURRENCE S111000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED avn $100 000 ES fEa oentel CLAIMS MADE ®OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY MOM= GENERAL AGGREGATE $2,000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 }( POLICY 4 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea amdem) S ALL OWNED AUTOS BODILY INJURY c SCHEDULED AUTOS (Per persen) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE S DEDUCTIBLE S RETENTION S S WC STATU• 0TH• WORKERS COMPENSATION AND (jg IR EMPLOYERS'UABILITY E.L.EACH ACCIDENT Is ANY PROPRIETOR,PARTNEFLEXECUTIVE OFFICEMMEMBER EXCLUDED? El DISEASE-EA EMPLOYEE S If yes.describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1 S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT1 SPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL IG DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRE NTAT ACORD 25(2001!08)1 of 2 US33484/M33480 ML 0,AdbRD CORPORATION 1988 Massachusetts Department of Public Safety Board of Building Reguiations and Standards License: CS-067560 CO)strljci oru Supervisor SHAUN M TWOMEY 4 61 PATROIT ST � NORTH ANDOVER MA 01845 ' ��,/►L' -"-- Expiration: Conr issioner 10/25/2017 Office�Co> umer$Aff IYS&�t�SIIC �'"~ �� � C�c�zucfiE�it s Regulation HOME IMPROVEMENT CONTRACTOR Registration: 174377 Type: Expiration: 2/4/2017 LLP DAMPHOUSSE ROOFING LLP SHAUN TWOMEY 87 BELMONT ST N.ANDOVER,MA 01845 Undersecretary