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HomeMy WebLinkAboutBuilding Permit # 7/22/2016 �pKrk q p "r BUILDING PERMIT �41 -i . o� TOWN OF NORTH ANDOVER APPLICATION FOR PIAN EXAMINATION L �* Permit NO: Date Received SACHilS 7-T N Date Issued: IMP RTANT: Applicant must complete all items on this pale L OGATI®N ... ✓ nB PROPERTY C�WNR Print MAP NOPARGEL ` ONENG C}ISTRIT Nrstarr Drstrtct yes hc� Iichi Shap Vllt ::. eS e ftp , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition )(Two or more family Industrial ____XAlteration _ _ No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition : Other l Septic WWII Fladfpiarn' I�letlarrd 111latersled bis 00 p: lllaterevue> Z) i ��S )i V) 1 o r) -hoy w I a ` VA ho(As e- cry) L i-P I� g x _ I G S�,Ua rem Identification Please Type or Print Clearly) OWNER: Name: QV r o_- P one: 6$6 ` ASO Z Address: prcwec�f I COIVTRATOR Marne Rho e ]� -- Addcess Supery s:&s Cor�strt�ct�on Islcense Exp Date Horne Irt7rovemertt License Exp date ARCHITECT/ENGINEER A)A Phone: Address: Reg. No. FEE SCHEDULE:BULDlNG PERMIT.-$12,00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$1 .00 PER S.F. Total Project Cost: $ �2 ' - FEE: $� Check No.: 'A T Receipt No. NOTE: Persons contracting with a ,registered contractors do not have access t th guaranty fiend Si rYature of en, wn - Sr rrature afcor�tr;ict 9 :.. _ . . . cyr� tkORTH own o ndover )0 No. - 2 _ y. h ver, Mass T Q LAKE ' ' 'Q COCN[C NlWKK � Rama U BOARD OF HEALTH Food/Kitchen PERMIT T. LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR qW has permission to erect .... build' s on .,........ ,,. . .. ,.,,, ... Foundation .. ' Rough to be occupied as ,. .. ., .. . .....f ... ................................................................... Chimney provided that the person accepting thrmit shall in every espect 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 CONSTRU TIO Rough rY ,� Service _ ..._...... ... .••..• .. BUILDING�INS ECT �L�• Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough 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 Approved by the Building Inspector. Burner Street No. Smoke Det. III 11111 I I Ill III Office Location: BOSTON Proposal Date 07/20/2016 liobNumber 20712640 Sears Home Improvement Products,Inc. Customer Nams /+ P.O.Box 522290 JOSEPH vavizA 0,111rs 1024 Florida Central Parkway Customer's Home Phone 7Customer's Work PhoneSit. Longwood,FL 32750-7579 (978) 686-3502 Home Improvement Products Phone(800)469-4663 StreetAddress ESTIMATE AND PROPOSAL Contractor LicenselRegistration Number 69 PROSPECT ST MA(148607) city State zip Code Roofing All plumbing and electrical services performed by NORTH ANDOVER MA 01845 Is installation within city limits? licensed subcontractors Installation Address County ESSEX (Yes/No): YES FEIN 25-1698591 Billing Address(if different from above) City State Zip Code ['reject Consultant Name&License No.(if applicable) RALPH MUDARRI BOSTON Description of the Project and Description of the Significant Materials to be Used and Equipment to be installed The work to be done under this contract includes the following(where checked): Specifications(CZI=Included ❑=Not Included) Preparation 1. © Tear off existing roof shingles down to woad deck on entire house. 2. M Inspect wood deck for rotten wood. 3. © Replace any rotten wood found in the deck area at a rate of$ 3.20 per square foot. PLEASE NOTE:this amount is not included in the TOTAL.PRICE shown below. Customer and Sears agree that the TOTAL PRICE will be amended via a Contract Change Authorization form to add the costs of replacing rotten wood in the deck area discovered after existing roofing materials are removed. Customer(s)initials IF Installation 4. Z Furnish and install Exterior Shingle: TYPE: DURATION COLOR: SHASTA WHITE 5. © Furnish and Install PROARMOR underlayment over roof decking. 6. ❑ Furnish and install ice&water eave&valley protector. 7. 0 Furnish and install starter shingle on all eaves. 8. 0 Furnish and install/replace any deteriorated"L"flashing. 9. Z Furnish and install metal drip edge along rake edges and eaves. 10. ❑ Furnish and install skylight systems. ❑ Reuse existing 11. 0 Furnish and install new vent covers on all vent pipes, 12. M Furnish and install attic ventilation system(Check all applicable): ❑Turbines ❑ Power vents © Shingle-over ridge vents ❑Off-ridge vents ❑ Soffit vents 13. ❑ Furnish and install new flat roof Exterior Protection System: COLOR: Gutters 14. ❑ Furnish and install guttering: COLOR: 15. ❑ Dispose of old guttering. Clean-un 16. 0 Clean-up and removal of all job-related debris including excess materials. (Extra materials are shipped with each job to avoid delays),Manufacturer warrant will be sent upon completion of installation, Sears recornmends that Customers have their chimney siding or mortar between brick,stone,or blocks inspected periodically by a professional and tuck pointed andlor waterproofed as needed. Sears shall not be responsible for chimney integrity other than Customer(s)initials replacing the flashing in conjunction with the installation of the roofing materials described above. Additional work to be done:R&D OF TWO ANTTENNAE Work NOT to be done: Repairs and replacement of any damaged existing structural members. Interior repair to walls or ceilings including sealing, painting,and/or drywall repair. Removal and/or re-installation of items that may otherwise impede Sears'ability to install a now roofing system prior to installation. Examples include, but are not limited to, satellite dishes, solar panels, pool heating panels, gutter protection systems,TV antennas,HVAC systems,and weather equipment, TWO FRONT LOWER ROOFS & LOWER REAR ROOFS SPECIAL INSTRUCTIONS;NEW ROOF ONLY ON TOP OF MAIN HOUSE All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s)initials �/ "Special Instructions"sections have been reviewed and explained to me. SR]-MA (Dig.) Rev 06/07/2016 Page 1 of 3 Job Number: 20712640 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THEAGREED TERMS TO THE EXTENT OF THEAVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY[FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS, IF YOU WISH, YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170 Boston, MA, 02116 Telephone:(617)973-8700 Please note that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system,or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system,or any portion thereof. If it is determined or reasonably suspected that asbestos is present, either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work,Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor, hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C,M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES vwx 07/20/2016 07/20/2016 Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 07/20/2016 by: Date Management Representative .) .-MA (Dig.) Rev 06/07/2016 Page 3 or 3 The Connnonwealtli of'Massachusetts = Departnrent of Industrial Accidents o I Congress Street, Suite 100 Boston,MA 02114-2017 w, rvwit:mass.gov/dia Workers' Compensation Insurance Affidavit: Btii[det•s/Conti•actors/Electricians/Plumbers. TO 13E FILED V1 IT111 THE PERMITTING AUTHORITY. A >>licant Information Please Print Le ibl Name (Fat,sirless/Orgatliiation/In(lividtlal):Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Phone fl: 860-753-0452 Are you an cnrployer?Check the appropriate box: Type of project(required): I.❑I am a employer with employees(full and/or part-time).* 7. ❑ New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition 3.❑I and a homeowner doing all work myself.[No workers'comp.insurance required.]+ Ip ❑ C3tlildingaddition 4.[]1 am a homeowner and will be hiring contractors to conduct all work on my property. l will ensure that all contractors either have workers'compensation insurance orare sole I LE] Electrical repair's or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general colttractorand I have/tired the sub-contractors listed on the attached sheet. 13,®Roof repairs 'these sub-contractors have employees and have wor€;ers'comp.insurance.' 14. �V 6.❑✓ We are a corporation and its officers have exercised their right of exemption per MG],c. Other' � 152,§1(4),and we have no elnployces.[No workers'comp.insurance required.] r.. r-r.r r *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I lomeowners who submit this allidmit indicaling they are doing all work and then hire outside contractors mus€submit a new affidavit indicating such. *Contractors that check this box must attached an addilimlal sheet showing the name or the sorb-contractors and state whether or no€those entities have eulployees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy ncmtber. 1 ani aii eniplovet•that is p1•ovitlitig wat'kei,s'eotnpensatioti iiisitrratice for my enlploj7ees. Below is the police acrd job site infn•liration. Insurance Company Name: Ace American Insurance Company i Phone : 866-283-7122 Policy#or Self-ins. Li[c.It WLRC48589650 1 ! Expiration Dat : 08/01/2016 p Job Site Address: ! eQ' s un City/State/Zip yrf%JKz . �F�� Attach a copy of the workers'compe sation policy decla ion page(showing the policy number and eL-ax iration(late). Failure to secure coverage as required under MGL c. 152,SS25A 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 DIA for insurance coverage verification. I do hereby cel- i ler the painstl penalties ofpgjuq thud th ht/or-r1111011 prrn 'ded above is true and core-ect. SigE�atu it-�+ _Dale: �/ � Z 2-0 - 53-0452 Official use onlh. Do not write is this area,to be completer/by cit),or town official. City or Town: Permit/License It Issuing Authority(circle one): 1. Board of Health 2. Building Department 3,City/Town Cleric 4. Electrical Inspector S. Plumbing Inspector G.Other Contact Person: Phone 4: RESET FORM F DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/2512D,5 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 HELOW, 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(ios) 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 v NAME: Aon Risk Services central, Inc. PHONE (166) 283-7122 FAX (800) 363-0105 m Chicago IL office (Afc•Na.Ext): Arc,No.: p 200Fast Randolph E-MAIL o chi cago IL 60601 USA ADDRESS: Z INSURERI5)AFFORDING COVERAGE NAIL N INSURED INSURERA: ACF American Insurance company 22667 Sears HOldincis Corporation INSURER B: ACEs Fire underwriters Insurance co. 20702 dba Sears Home Improvement Products, Inc INSURER C: Attn: Risk Management E3-219A 3333 He VerlY Road INSURER D: Hoffman Estates IL 60179 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570058793162 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSi1RANCIE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TETE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT-TO WHICH PHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE.AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E=XCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested I-TR TYPE OF INSURANCE IVSD N1V0 POLICY NUMBER MMrgq/YYYY MMlDD1YYYY LIMITS A X COMM[RCIALGENERALLIABILETY HDOG27397 38 ON'T01 2 5 1201 EACH OCCURRENCE 55,000,000 CLAIMS-MADE ❑X OCCUR O $5,000,000 PREMISES Ea occurrence MED EXP(Any one person) Excluded PERSONAL&ADVINJURY $5,000,000 W GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S5,000,000 m K ❑JPRO- POLICY ❑LOC PRODUCTS-COMPIOP AGG $5,()00,000 OTHER' p n A AUTOMOBILE LIABILITY ISAH08859000 08/01/2015 08/01/2016 COMBINED SINGLE LIMIT 55,000,000 A ISAH08859012 06/01/2015 OB/01/2016 Ea accident AANY AUTO ISAH08859024 08/01/2015 08/01/2016 BODILY INJURY(Per person) Z X a ALL OWNED SCHEDULED BODILY INJURY(Per acddenl} AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS �I e_r accident_ 4:. IU UMBRELLA LIAR OCCUR EACH OCCURRFNC-F L) EXCESS L'_ CLAIMS-MADE AGGREGATE DEO RETENTION A WORKERS EMPLOYE RSO COMPENSATION ION AND wcuc48589662 08/01/2015 08/01/2016 X STATUTE £RH ANY PROPRIETOR f PARTNER I EXECUTIVE Y!N OR, WA, lW • QFFICERWEMBER EXCLUDED? N NIA wLRC485896SO 08/01/2015 08/01/2016 C.L.EACH ACCIDENT $2,000,000 (Mandatary in NHl All Other States E.L.DISEASE-EA EMPLOYEE $2,000,000 Ir yes,describe under DESCRIPTION OF OPERATIONS below E.t.DISEASE-POLICY LIMIT 52,000,000--�--- DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES IACORD 101,Addi3innal Remarks Schedule,may he attached If more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 'r HE POLICY PROVISIONS. c Sears Home Improvement Prod UCtS, Inc. AUTHORIZED RCPRESFNtATWE 1024 Florida central Parkway JR Longwood FL 32750 USA Oc 1900-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD E i Y q 4 Ile,(i i( ' 1�1' '6I/C I' f (�t fdC,'J L m/'J'e '�" i 4 ,u Office of Consurner Affairs nd .Business Regulation 1.0 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement ontraetor Registration Registration: 148607 Type: Supplement Card SEARS HOME IMPROVEMENT PRODUCT Expiration: 10!1912017 LUBOS SVEC 1024 FLORIDA CENTRAL PKWY LONGWOOD, FL 32750 Update Address and return card. Jlark reastin for eh:4rne„;e. Address Renewal i Employment Lost Card �In � rip Jn.Gd n•rrt�/�!�-.'>fl.�r11�i'f l�.fr-1�; ttlCi'uf('IrElsanlCl':1trllirti& RUtiikleSti 1';l` €II€4111113 L,rccow or registration Valid for indivitltlal lyse only q�fiOME IMPROVEMENT CONTRACTOR before the expiration date. If t'auud return to: Office of Consumer Affairs alt€I Business Regulation Registration: 148607. Type: ltl I'ar•k Plaza-Suite 51,70 Expiration.: 14111(2017 Supplement Card Boston,!1A 02116 SEARS HOME IMPROVE:MENT,PRODUCTS INC. LUBOS SVEC 1024 FLORIDA CENTRAL PKWY i..LlNGVU0010,FL 32750 ['ndclsccretnr, Not€,,IIi I NA,itl3otit si8nature 3 I i t-�D;fa nk tion i't !-Iceaf:se; CS-097519 yi n LUBOS SVEC 827 THOMPSON-R' 0"., Thompson CT 06277 `f € c:r4c;�iss"r<rrllrr 08131/2016 C C 1 k i B€ E