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HomeMy WebLinkAboutBuilding Permit # 8/18/2016 ...... ............. pORTH BUILDING PERMIT o*�Ttf� TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATIO " Date Received Permit No#: d � �Ssacwus�c Date Issued: W ORTANT: Applicant must complete all items on this page LOCATION z- PROPERTY OWNER I C6_ 00b)Print Print 100 Year Structure yes Ono MAPbl, PARCEL:_' J _ ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial 'Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Se�t�c B 1Ne11 ❑ FlistrEct DESCRIPTION OF WORK TO BE PERFORMED: _ Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: ,I1 Contractor Name:E<710 Phone: Email: Address: 7 �l Cr CfLLs Supervisor's Construction License: C19 Exp. Date: Home improvement License: � ��� �� Exp. Date: ���� ��''� ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL.ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C FEE: $ Check No.: Receipt No.: p NOTE: Persons contracting with unregistered contractors do not have access to nd - _ . � �®R�'1}�p '� Town of *. bAndover o rt `� 0 No. �- Z ver, Mass, A AISI-A's [OC NtC Ft wtCF ao�ArED S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT .............ELLiii..LJL............... .................................,. ..........................,.. has permission to erect.......................... buildings on .., �...., . ( ,' „ ! ',,,,, , ,,,, Foundation BUILDING INSPECTOR ......... Rough to be occupied as .......w5 f . ........4J.M'W................................................... ............ Chimney provided that the person accepti 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 NTS ELECTRICAL INSPECTOR. UNLESS CONS 10 S Rough Service .. ...., .. .. ....... ...... ....... Final BUILDIN SPE TOR 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. Dempsey Roofing LLC P.O.BOX 383 Billerica, MA, 01821 Phone: 978-670-8904 www.dempsey-roofing.com Fax: 978362-3102 8117116 Contract Customer Name: EUNiCC ( OV Address: 31 Upland St. City: North Andover State: MA Zip: 01845 Description: • Install tarp from roof to ground to protect siding & landscape + Strip existing 1 layer down to roof deck. Inspect & re-nail where necessary. Any broken or rotten plywood will be replaced up to 1 sheet %2" CDX. Any extra replacement will be at an additional cost of time and material. • Install 6' of ice and water shield underlayment along all eves, 1,5'under cheek wall flashing and 3' in valleys • Install 151b paper on remainder • Install 8" white aluminum drip edge around entire perimeter • Install LTD Lifetime GAF Timberline HD or CertainTeed Landmark architect 16 AG 9f roofing shingles (color& manufacture chosen by homeowner) • Install one new 3"pipe flange • Will use current step and roll flashing • Install cap shingles over ridge vent to ensure proper ventilation • Remove all roofing debris • Material, labor,permit and dump fee included Total: $8800. Ten year warranty on all workmanship Signature of acceptance Cr,'t, / Dempsey Roofing LLC L ,�Yt cla r , G The Commonwealth gf'Massachusetts De paptment ofindustrialAccidents hM'-- F d I Coagressstreet,Suite 100 `e Boston,MA 02114X017 , yY+v� www.mas's.go-Yldia WD kers'Co:mpmsaijonImuranceAffidavit:Builders/Contractors/Electricjaus/Plikmbers. TO BE FLED WITH THE l'ERNUTUNG AUTRORUY' A licaazt l�xfoxlmatinn Please Print Le 'bl Nail o(Basivess/orgamationgndivzdual): Addre,ss: Gity/State/zip: Axeyou an employer? 6e&t&aplr'opriafe box: Type of project(reclulr4l): 1.�I am a employer Wth 3 � employees(fall and/orparC time).* 7,• EJ New ca sttuction 2..EJ I mn a sole propri.etoror partnership and have no employees WaddDg forme in 8. Remodeling any capacity.[No workers'comp.insrzcauce required.] g Demolition 3 Q 1 am abomeownexdoing all woY-kmyselz[No workers'eomp,13sorauce squired.]_ 0 gaddition 4.[]lam a homeowner and will be hiring contractors to conduct all work on my property. Swill ensure that all contractors either have workers'compensation insurance or are sole ll.Q Electdcal repairs or additions pvipirietors withno employees, 1i Q Plumbing repairs or additions 5.F]I am a goneraI contactor and I have hired tho sub-contractors listed on tho attached sheet. l3_W Roe fjepairs Whose sub-cnntraotorsl veemployees andhavoworkers'comp.insumcO ld•.[ Othbr 6,0 We are a corporation dad ifs ofgers have exercisedtheirright of bxemptionperMGl.c. 152,§1(4),and uwehavo-40 ayaes.roworkers'oornp.insmanceicquired.1 *Any applicautthat ohac:ks bdx41 must also out the seotion below showingtheirworkers'compensationpoIiay in:ovnatien Homeowners vvlio sulil if V,g a&davit indicating they are doing all,woricand then hire outside contractors.muatsitbmit a nevi affidavitindicag such (Contractors that checkthis box must•Attagred an additional sheet showing the name of the sub-contractors and state whether ozgotthosa entities ha_ve employees. Ifthe sub canirac`tors have employees,�IieymusE prosidotheir workeis'comp.policy number. I ain an employer&at its p/'ovaairxgjvorker�s'com_penSatiorr insu?arzcefor my err2�rloyeey'Belo'w is t/iepolicy aril job site info�rnatior2. A/UT U�Z Insurance Company Name: / / 13 �U Q /�l (�7 Policy#i`-or S elf~ins.Lie.#,4 d �0�7� �"7'2O P 6 � �pira�a�Date: 7l Job Site Address: / U pz— 9�/> "S` / City/Stat,)/ V: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure eovezaga as required under M(3L c. 1.52, §25A is a criminal violation punishable by a flue-ap to$1.,500.00 and/ox one-year jmprisonm mt,as well as civil penalties in the foam of a STOP WORK ORDER and a fine Qj up to$250-00 a day against the,violator.A,copy of this statement:may be forwarded to the Ofco oflnvestigatlorts of the DIA for insurance coverage verii7catiou.. X do liexeby certif u er z andper�alties ofperj'rrry t1tat the information 11 r avide above is it e ar2d coni ecf Si at€tre: Date: S Phone##: Official use only. Ao n0t-Wr Ue in this area,to be completed by city Or town offaciaZ City or Town: Peranit/I zcearse Issuing Autla ort—(circle oaite): i 1.Board of Health. 2.BuildingDepartmeaat 3.City/Town Clerk 4.Electrical Inspector 5.Plumbingluspector 6.Other Contact Person: Phone#: I DATE(MMIODNYYY) CERTIFICATE OF LIABILITY INSURANCE 07/08/2016 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 Richard Beer-off NAME: .... .... ...._ ._....... FIRST INSURANCE SERVICE, LLC PHONE p.EM (978)531-4461 i�rc,Nol: EMAIL info firstinsuranceserviee.net AtlDRES,SC�3 _--...,_ - ..__....,. 11 WHITNEY DRIVE INSURER(S)AFFORDING COVERAGE _ NAIC# PEABODY MA 01960 INsuRERA: -AIM MUTUAL INS CO 33758 INSURED INSURER a: DEMPSEY ROOFING LLC INSURERC: INSURER 13: P O BOX 383 INSURER E: BILLERICA MA 01821 INSURER F: COVERAGES CERTIFICATE NUMBER: 67431 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 SUBR - w POLICY NUMBER ^^ ^ @4MIDDYlYYYY MMIEFF ODP(YYY) LIMITS LTRINSD VE) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE Tc�11i;NTED ---� CLAIMS-MADE OCCUR PREMISES(Ea occurrence $ MED EXP(Any one person) $ NtA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY Ei PRO- a LOC PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY COINEDa accintSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED N1A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE - $ ,,,,(per accideniy UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAWS-MADE NIA AGGREGATE _ _$ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERER T AND EMPLOYERS'LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE --- E.L,EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED9 NIA NIA NIA AWC40070274872016A 07/01/2016 07/01/2017 (Mandatory in NH) E.L.DISEASE-_EA EMPLOYEEI$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT=" D0,00D NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks 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.govllwdlworkers-compensationlinvestigationsl. CERTIFICAT OLBE CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN (Derey Roofing LLC � ACCORDANCE WITH THE POLICY PROVISIONS. 3 AUTHORIZED REPRESENTATIVE Merica MA 01821 Daniel M.Cro y,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 CERTIFICATE OF LIABILITY INSURANCE 113/18/2016 ATE EMWDD1YYYYI 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 he 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 Commercial Lines NAME: Prescott and Son insurance Agency,Tnc, PHO,E Ext): (781)322--2350 JAX,No): 963 Eastern Avenue EMAIL ADDRESS: INSURERIS)AFFORDING COVERAGE NAtC ft Malden MA 02148 INSURERA:Endurance American Ins Co INSURED INSURER B Dempsey Roofing LLC INSURER C i 7 RICHARDSON ST INSURER D: INSURER E Billerica MA 01821 iNSURER F: COVERAGES CERTIFICATE NUMBER:CL1631822656 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 0I INSURANCE I_IS'ILD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTVIA HIST'ANDMO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MACH THIS CE=RTIFICATE MAY BE ISSUED OR MAY PE=RTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED H1 REIN IS SUBJECT TO ALL '3'lIE_ TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN RFDUCLD BY PAID CLAIMS INSR - . . . ADDL SUFIRI - _ .. P.LICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER I MM1p01YYYY tAMIDDIYY Y LIMITS X COMMERCIAL GENERAL LIA UILITY lir;t;tl{)(;Gi.lR3t faJCf_ 5 1,000,000 15AMAGL-I()VE-NI F D A I Gi,al^AS t411.:F X UCCIIR PRL MISE";([a acc)arence} 5 100,000 ... .... CBLC20000050401 9/3/2015 9/3/2016 _..;,:D E:;XP(Any(3lne pe:sun) $ 51000 PL.RSONIAI S A€JV INJURY 5 1,000,000 `GENT_AGGRLGAI F!.IrAir i i F LICs PFR CL:NeRAL.AGGR[(iAlE 2,000,000 X POLICY - PRO- PRODUC1 S-COMP)OP AGG S 1,000,000 .. JElC7 . AUTOMOBILE LIABILITY CO UNFO 91N64.E€.IMI] 5 i..4L3 acs Uenpj ANY AUTO 601'3I1 N.JEJRY(Pef prxsanj i. ALL O'JviNI D S.:;FtI::EJt1LE;€) - - ;AUTOS AUTOS HODH y INJURY Illu acndl nlj„ C� NON OAINI.D bl2(11 k'-r?EY Ilh"4AGE - FIIEiI'.O i,IJTOS AUTOS I _ {fief at.ut'.en!i [ UMB RFLIA LFAB '.. C;CCUR E.i.0 11 UCCUftR EC.(:L:: 5 EXCESS LIAR CLAIMS M,i(.}} I I. fiGC'I FGA i E-' `S OLO R@.7l'."N1 ION 5 - WORKERS COMPENSATIONI{- AND EMPLOYERS'LIABILITYSTATUIF'. 'Eat Y 114 .... :ANY PROPRII:i.'IOR1fARTNERIEXE-CUf !Vr E.:L. E,ACFi ACCIbL=NT OFF"ICE WIVEMBE::R CXCI.ODF;D'r I':NJA' itAartdatory in NH) EL. DI f`_E SIS-rri[=f:SPt.OYI,}', 5 fl yes,Aescffbc antler _ - ;OL SiUflp UN OF OPERATIONS halo'., Lt iJi9f;lt5 F. POLICY LEM'.T 5 DESCRIPTION Of OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,rimy 1,e attached it pore Space is re quiredE RE: 59 Salem Road, North Andover, Ma 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Strer?t ACCORDANCE WITH THE POLICY PROVISIONS, Building 20 Suite 2035 AUTHORWI-D REPRESENTATIVE North Andover, MA 01845 7 Cc)19BB-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 cxJlaol) Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099681 Construction Supervisor Specialty ERIC DEMPSEY a' P.O. BOX 383 BILLERICA MA 01821;..:_. l.JL— Expiration: Commissioner 05/2312018 'U C��/e �Lna-err-Jrrc1�rcnnrc%� a�'C?/l�r,t.frir.�rcte/lt y i Office of Consumer Affairs&'Business Regulation OME IMP ROVEMENT CJNTRACTOR ''Re istrat�on: 178026 . Type' 9 3 _ Irxplrat�on 31612D18., LLC DEMPSEY ROOFING LLC ERIC DEMPSEY 7 RICHARD ST BILLERICA, MA 01821 Undersecretary