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HomeMy WebLinkAboutBuilding Permit # 8/18/2016 BUILDING PERMIT IE ,%AO1 A• 3�O�Z? ° rbT6-r� TOWN OF NORTH ANDOVER o :<a APPLICATION FOR PLAN EXAMINATION _ J � Date Received �pQ� ATEO,P�"^\� Permit No#: � � 4SSACHus�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION v Print PROPERTY OWNER ar-To'n - Print 900 Year Structure yes no MAP 7 PARCEL:ZONING DISTRICT: Historic District y r no Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition © Two or more family ❑ Industrial iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: F1 Demolition ❑ Other ®5epttc ❑We11 ❑ at tr Floodplain ❑1Netlands fl 111! ershed Dis ict p 1NaterlSewer '' ... ,. r l DESCRIPTION OF WORK TO BE PERFORMED: dentification-- Please Type or Print Clearly OWNER: � �;, _ r� ,_- Phone: Name: Address: a Contractor Name: 1 . ; 411 Se �� Phone: q Gs-c-9-ycl 2 Email: Address: o 5C Supervisor's Construction License: D-S-qq 3 Exp. Date- Home Improvement License: j '7C S-7 S__ Exp. Date: ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_d,(9, FEE: $ 21-5h Check No.-. - Receipt No.: 261 NOTE: Persons contracting with unregistered c ntractors do not have access t1ax a fund t4ORT� Town of F:. 6Andover 0 ' _ "� TO ..... IBM No. 79, 0 LA - r FIE h verMass, LOCFC M49C A MlwKw � S l7 BOARD OF HEALTH Food/Kitchen PER RT Septic System THIS CERTIFIES THAT t �a� ... BUILDING IINSPECTOR ............... ........... ............... ,..... .........................,....................... has permission to erect .... buildings on .. .�....�, D .�. ,�. ..... ... Foundation ...,.. ........... • ............. • Rough tobe occupied as ............ ......... ......... ......���0�......................................... . . ................ chimney . , .. provided that the person accepting is 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 CONSTamom I Rough Service . .... ... ..... Final BUILDING SPE OR 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 Approved by the Building_ Inspector. Burner Street No, Smoke Det. �D Vi,nceoot :)tangelo 3 Hodgson St. Tewksbury,Ma 01876 � |.met Tf �r) ��/�W� (OR0ING _ .. __ Customer: PREf ERRED CONTRACTOR A), Ai�Lve, r~ C Description ofwork Performed* &workers compensaUon Obtain required town permits� p'ovid�cartiO�m�e�of insurance Provide Dompsderset onplanks*for contra ot�*au�emn\y(ouator�a\eaUrooyo|�d) Attach Large Tarps to protect adjacent finishes, landscaping,and property. Strip-off existing layers mYroofing oncomplete house&re-nail any loose decking Aluminum Corning StodarShingles |nataU8|nchl�\ J�_ around all penetrations � m ford) /zqf install Owens Corning ice&Vatersbie|dGftmtaovea' %ftinvalleys, Install Synthetic felt paper tmentire roof TruDehn|�unOurat|onahing|es-/Lbu*e /9~5/ -�0-q� ew -��- Install Owens Corning L|foTimmewurrenzy 'y Install new neoprene vent pipe flashings on all plumbing pipes , install Owens Corning VentBunn ridge venting with moisture guard install Owens Corning PpoEdgohip&ridge cap shingles ~ Completely re-flash chimney with lead warranty Owens Corning Preferred contractor inetaUationwithYu|\ `.' All work will be completed according to state and manufacturing codes and specifications. Every day we will have the roof water tight,clean gutters,completely clean the job site,and use amagnet roller tocollect scattered nails. Additional work to be performed ctices, Any alteration or deviation from the above bove nteed to be as specified, All work to be colnPleted if)a workmanlike manner according to standard pra T All maleriai is guara form and may become an extra charge over arid above the amount stated herein. This specifications must be made in writing on an Add-on/modificailon of contract a do and other necessary insurance,our workers are tui�y covered by Worker's compensation agreement is contingent upon delays beyond our control.Owners to carry fire,tome I defaults, homeowner agrees to pay all costs of collection, including reasonable insurance. [iomeowner agrees to pay for all work as set forth below. if the homeowr er attorney$fees,in addition to other damages incurred by contractor.Full Payment Is due upon completion of work, We propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum dollars($ �o(c't o c) amount shall be paid as follows: Note�This proposal may be withdrawn by us if not accepted within L-)(L)_d a y s, THIRD BUSINESS YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO IDPOGHr IX46E OF CANCEL TION FOR AN ATTACH NO DAY AFTER THE DATE OF THIS TRANSACTIOW SEE THE OME OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PRO I IONS bF THE H SOLI ITATION SALES EXPLANATION IT BLE dl ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGC Work will not begin until your right to cancel has expired and y dollars($ unless this agreement pr id' s othe, Signature of Contractor or authorized representative:- b o e/us),and(I[We)find them to be satisfactory *(IMe)have read the terms state h in they allve been explah)ed and hereby accept them. Signature of Homeowner(s): � U 'die Commonwealth of Masyq� husefs . T)epagment ofIndustrial accidents u -1 Congress Street,Smite 100 — ' y .Boston,MA 02114-2017 , ra�ass.govfdic ,Y. Wo3:kms'Cox:upinsatioubnsuranceAffidavit: erg. TO BE NLVD W.ZTS TBE PE MTTING AUTHOPXI.'Y. A-pplfcaxxtInforMatiaxx I'IeasePrint Le ` Nance (Bitsiness/Organizationllndividu4: kror+c .Address: v Cid/StatelZz : Phone Are you am empleyor7 Check the els xaprlaie box: Type ofproject(rgclui od). 1. I am a employe WfEL employees(full andlor part time).* 7.• Q New construction 2, I am a sale prapaetor or partnership and have no employees wozlcing for me in $. Reno�a clelixig any capacity.[No workers'comp.instm'ance requirad.l �. ❑Demolition. 3.Q lam ahomeowmerdaing all workmyseIf[No workers'comp..iusuramce required.l t 10 F]Building addition 4.0 I am a homeowner and will be hiring contMetars to canduct all work on my property I vain ensure that all coutracfors either have lxtorkers'compensation insurance or are sole Electzical repairs or.�dditions proprietors withuo employees. 12 Plumbing repairs or additions :5.Vageneral contractor and I have hired the sub-contractors listed on the attached sheat, x 3_C(Roiifr'ep air S these sub-contractors have eiployees andhave workers'camp_msluance. 14.[f Outer 6.Q We are a cozporatien.pd#q pf p,prs have exercisedthe}r right of exemption perMCTL c. 1.52,§1(4),and we havena,e; plRpeF.[Kpworkers'pomp.insurancerequired.] Any applioantthat checksbox#1 must also,RU.outthe section below showing tbeirworkers'campensationpolioy informatien i Ilomeowners vrlio submit j�is a f,�idavitindicaiangthey are doing all workandihenhire outside contractors must si�bjt anew aft;davit i€tidicatang such tContractors Pat check ibis box must•Attached an additional sheet showing the name ofthe.sub-contractors aad Matz whether orpot those entities have employees. If-the sub-coriQfors have sraploy�ees,�liBy must providetheir workers'comp.policy number. lain an eryaployer tTzat is providingxvo,-Aers'compensation insurancefor7n employees'BeLo3v zs thepolicy acidjob site information. Insurance Company Name: t 06$ ��--d RKpiration Date: /8/1 Palioy#or Self iris.T,ic.#: ,} I'ob Site Address: 5� n City/State/Zip: 1 / &Ltacb.a copy of fhe WGYkers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152, §25A is a criminel violation punishable Tag a fmo up to$1,500.00 and/ox one-•year imprisnnrnent,as well as civil penalties in the f0XM of a STOP WOM ORDER and a fine of up to$250.0 0 a day against the,violator.A.COPY of this statement may be forwarded to the Offico of Investigations of the DIA.for insurance covexage verlfic 'ono.: l do Aereb exyif rid lz& ains and penalties of perjury Mat the infbx'manon,provid'ed aX�o;�e is rue a,d corgi ect. ��`�� _�.-•------ `"..�".._ Date: !I Si a e: Phone#: Dfficial use onry. po not-wpitein this area,to be comapleteci iiy city ar town official, City or Town: PexsnitlLicexxse# Issuing Authority-(Oxcle;one): i 1..)3oard of Healf1i 2.)3uiidingDeparhRezx-t 3.Cvvown Clem 4.Electrical Inspector 5.PlumbaingluspectOr 6.0 ther Contact Person: Phone ; DATE I EAhi 1D LY YYYY I CERTIFICATE OF LIABILITY INSURANCE --' e 1.8/ .s.. 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, (fie poficy(ies) must 110 endorsed, If SUBROGATION IS WAIVED,subject to the terns and coridilions of the policy,certain policies Inay require ao(ndorsement, A statement ori this certificate sloes riot confer rights to tfie certificate Bolder Ili lieu of such en[Eorsenient(s}. PHOWCER CONTACT NAME: Angela Wa_sten insurance Agency PHONE wax (978) 735-3095 lfuc.xA. xtJ (979) 557 Central Street ENTAIL ADDRESS: ancrela@aWS ten.G'OXIT Lowe11, MA 01852 _..._ 3NSLIR ICEOJ A}FORDIW COVERAGE NAIL if kNSURERA.ATLANTIC CASUALTY INSURANCE CO tsuRED MSURERn;HARTIiORD UNDERWRITERS INS COMP Ia O CONSTRUCTION CORPORATION INSURER 4 ASTOR ST AP, 4A INSURER D: LOWELL, HA 01852 INSURER E. f _ EN5URER F; COVERAGES CERTIFICATE N UMBER: REVISION NUMBER: ----- __ _�.._ - ITiIS 15 "O(,ERTIFY THAI THC POLICIES OF INSURANCE MTELI BELOW HAVE BLLN ISSUED TO TI iI INSUr2i_CJ�JAA+E1 E)r1E3clvl:FOR 1 Hk r'QE.Ir,l I'LRI()D INDICATED NOTWTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT 012 01111-R DOGUNIENI-4+11TH RESPECT TO+ I WCH THIS CL-RTIFICATC MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOWED BY TIE HCRCIN iS SUBJECT TO At.L THE TEEMS, EXCLUSIONS ANDCONDITIONS Of SUO-I POLICES,LIMITS S#-OM MAY HAVE BFEN REDUCEO BY PA D CLAll'AS. NSF; 'ADOI.SIJEIR POLICY EEr POLICY EXP LTR _,-, TYPE OF INSURANCE 3NSR 5.,� f�(}II C'Y NI1 t.1HER �h1 twi1(X)fYYYY�, ls3:'01DD'YYYY): Li ATS A GFNFRAL,LIADII.rY L021008696-2 -�/1E1/16 3/:.©/I7+', Er+(;HOCC:LENI.W .......... IJ ....1..,000..,00 Q. OAi.4�t L O REV[ED (_is Cats+n�Rci:,L(A-.V AL'LARis ITY _PP2E1 L�+.I_aY 'I:11�oJ- _ 10�}_.,_Q Q-a_-. C'-t.11lf •..i;tE/F ti ClJUft 1'.1-0 xP;iv:�u+l3 pvs�nj. 000 P+ IISfMr t N)V I14ik);i, 1,O00,0(30_ I c'_cNrE Et cert . IE. 2,000,000 . (;ENI.A,,'GRFGA I,. +iIAPKrhSPFR Fznni(A. i cziWJ3n1>nrsE_, ' > 1.,0()0,000 PLri.ICY J_GT 1.00 ! _ AUTOh10HILF.I.IAE111.}T'Y COr:a3MCNED S[NGLE:E.'<r„I "•NVAiIIC; L10LIIL.Y IN,IIIftY{Prr;v I.p.) h At L O 1•"?NF EI SCHLtJUi-f_D UONI y INJURY.:Pcnom, AU-10S AU 101", I tRTY NON OW14ED I ROP 1' rHT rllj : . UMBRELLA 1.111 q!t JT I. (:H Ul t_Ill lie-9;f EX(;LS _ DEERETEFI FION D WORKERS COMPENSATION 21:112068-16 _ "3/30/16'' 3/:30/17 all)EMPt-C) RS LIAHILIIY IC ItlL111,11 ER YfN ArNYI 2UPR€LiCtFUP kiiNCHE,>ECUi#V£ f 0. ri 1 ([LE141 3 100,000 ' Cf 11ULWIlEf"IMP Fnl:911`)E!3': N+A PSsIxIa Gary in NH) "' Il>,.. r ISt.A4F-t.A rt"f'I.OYEZ' `! 100,000 P ( ic es.t1 e I,! ,rraik+tlE]t.iLr!)Pert,li 1fJa'be1a:+� ,._. ._._.__.._......_. L! oiSEnSE I'(1LICYLJhIIT a• 500,0DD W SCRIPTION OF OPERA11014S 1 LOCA IION31 VEHICLES IAttach ACORD IDI,Atklitiol}ai Rarlu rks 5cliedute.if mare spew is re i;ti is It CERTIFICATE HOLDER CANCELLATION SNO t ANY OF THE A13OVE DESCRIBED POLICIES BE CANCELLED 13EFORE Tlll E Ai A DA' T THEREOF, NOTICE WILL BE DELIVERED IN 'TOWN OP NORTH ANDOVER AC OR � . ITH TH POLICY,JPROVISI INS. 1600 OSGOOD STREET SUITE 2035 .� NORTH ANDOVER, MA 01.845 AUTHORIZ Rr P46N)A'rIVE 1[368.2014 ACORD CORPORATION. All rights reserved. ACOR D 25(2014/05) The ACORD name and logo art registered marks of ACORD l"11011e: (976) 656-8497 Fax: C-Mail: vineentcolangelo@ sboglobal,not ,meq, C'���(' CQPI7791J.0-%GCUCCL[f�P/J�?���iidQf.YllklCff '. Office 0f Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Registration: 170575 Type: Expiration: 1.1110/2017 DBA CD ROOFING VINCENT COLANGELO 3 HODGSON ST TEWKSBURY, MA 01876 •{' a ,r Undersecretary Massachusetts Department of Public Safety Beard of Building Regulations and Standards License: CSSL_105943 Construction Supervisor Specialty VINCENT COLANGELO 3 HODGSON STREET TEWKSBURY MA 01978 ��� `� Expiration: COO nmissioner 03109/2018 R