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Home My WebLink AboutBuilding Permit # 8/22/2016 %AoRTH. BUILDING PERMIT g/ of Kt`ED �"Vo TOWN OF NORTH ANDOVER 1 - x APPLICATION FOR PLAN EXAMINATION � t n pp Date Received •�Q6�ATE0•Pa` i`� Permit No#: I' �ssACFiOS Date Issued: � IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER� �l� ' _ print 100 Year Structure no MAP PARCEL ZONING DISTRICT: Historic District yes r ono" o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 77777777 ❑ Septic ❑1Jllirll Floodplain ❑1Netkands ❑l 1Natershed District ' l�'1JIlaterlSewer SCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: 00,oz, Phone: Address: Contractor Name: , . Phone: Email: Address: ° � 030(,0 Supervisor's Construction License: - Exp. Date: 3 I Home Improvement License: 11 Exp. Date: 4' ARCH ITECTIENG[NEER Phone: Address: iReg. No. FEE SCHEDULE.SULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $_ FEE: $ Check No.: _Receipt No. 30I NOTE: Persons contracting with unregistered conactors do not have access to the guaranty fund �®R T#1 Town T ndover ® r ® * 1 h o LAi[E h ver, Mass, ot? 700Z L �A LOCH ICHEWICN � U BOARD OF HEALTH Food/Kitchen PERM T T LD Septic System THIS CERTIFIES THAT AIvR►4�. .... BUILDING INSPECTOR has permission to erect ........ ..... buildings on + ...... Foundation R`, " C. Rough tobe occupied as .. .. ... ... � ............................................................ chimney provided that the person accepting 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 MONTHS ELECTRICAL INSPECTOR - UNLESS C T I Rough Service 0,4 . .. ....... ...... .... ............. .... .... ... Fina BUILDING CTOR GAS INSPECTOR ccupancy Kermit Required to Qccupy By 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. July 26, 2016 l(j"E' David Maurer Wicked Smart Exteriors 88 Johnson St 149 Lund Ind N.Andover Nashua hih, 03060 978-661-7484 Thank you f6:°ce:r':stde::ng Sir:arfEsfe::ors, and giving rrs ffie opportunity to provitft,,you with a quality r~c:aofi::g :r:: cw ct. At S 1. Job Sl)eexlfications: Upper main roof and guest quarters 2. Job relaaratlon: O et erp job site; to ensure attention to your particular concerns. Install tarps around the arenas of the home, being worked on to prevent damage to siding, plantings and any landscaping, 1",w4e'll'I)V1 61)(1,1('66 . Shingle Application: *Install a Lifetime Architectural Shingle. Re-lead ( ) chimney d. Drip Edge: 8" drip . Ventilation: *rower fairs will be re-used. 6.. Hip & Ridge e;Twin les: oInstall new hip and cap shingles, this provides protraction of the ridge vent and a finished look to the roof line, 7... Roof IIV'amanty: ® I...imited Lifetime; manufactures warranty. BACK OUR WORK WIM A 10 YEAR WORKMANSHIP MIARRANTY ll.. glean-a.al)IMSPosak oWicked Smart Exteriors supplies the durnpster, Our disposal costs are based on recycling of the asphalt shingles. Please do not throw any household trash or foreign materials into the dumpster.We will thoroughly clean up and dispose, of all materials and debris associated with the job. 1 Your home will be treated like our own thrq!LgjioW the entire proms *Protection and clean- Scheduling: +We do our best to stay within stated scheduling;however, Mother Nature and emergencies can lead to delays. We will do our best to limit those delays. We will contact you within 48 hours before installing youf new roof and work will not be commenced until you are contacted first. If more time is necessary to accommodate your schedule, kindly let us know. Job Cost: Roof f: $11,250.00 Payments shall be made as follows: 113 deposit due before scheduling work, balance due upon completion of the work. QUOTE GOOD FOR 30 DAYS ONLY. SIGNING TNDXCATES ACCEPTANCE Or, THE PRICES AND SPECIFICATIONS SET FORTH HEREIN AND'ACCEPTANCE OF THE 'FERNS AND CONN S0 THIS CONTRACT. Wicice mart Exteriors: Ho _E ow et / Date: �!? Date Aute rued Representative Thank you, Ryan ppolan 978-551-7484 2 T ie Commonwealth of Massachusetts . a Depaytment oflndtfstpialAccidents 1 Congresv Street, Suite 100 Roston,MA 02114-2 017 www.mass:gov/dia -W,oVkers'Compensationh suxanceAffidavit:BUUdexs/CoRtractoxsXJgq acians/Plumbers. TO BE FMED'G ITR THIS)LBRWffTTCNG AUT](ORM A l:cantMo�r:matiom please Print Le 'bl 1�x Name(Business/O.tgawzatzonlxndividual):_`��tC��Q�( �1MIK C4 Address: ( I L} �t� U City/stata/zip: c Y� v'k Phono#: o 0 d iebox: Type of project(gg'Wred): Are uanemployer? Checl�tJzeapia npria 1, II am a employer Atb,� n� pmployees(full andlor part-true)* 7, Q New Corlstt�e�ell 2. S am a sola proprietozarparkxorship andhave no employees working fence in 8. Remodolirig any capacity.[No workers'oomp.insurance required-] 9. Demolition 3.❑Sam ahomeoamerdoiag all workmysel£[No wrakers'comp.-insuranee xequired.]t 14 L_I Building addition 4.Ell am.a homcowner andwill.be biring eontractomto conduct all wWk unmy property. 'will Electr cal ro airs or.additions ensure that all oonhactozs either have vaorkers"corupensatian insurance or are sole' - „ propxletors withao ein Wces. 12:El Plumbizag repairs or additions 5.F]I am a general contractor and l havo hired the sub-contractorslisted on the attached sheet. 13-'E]Roofr'ep=- s These sub-coniraatorsbave employees andhave workers'cam,p-wstrrance t 14.❑Other 6.Q We are a corporat vn?nd its overs have exezcised their right of exemption perMGS.,c. 152,§1(4),andwehavana.,em�loyees.[Noworkers'comp.insurancerequired-] '•. .. 'Any applicantthat cheelrsbox#1 must also fdl outtha section belowsbawingtheirwoxlcers'aampensationpolicy infomration. T Homeowners ilio mHjMi4&afftdavitindicatmg they are doing all workandthenhise outside contract—must s4bmit anew affidavit indicating suoh- ?Contractors that checT�this box rmust atEachec)an additional sheet showing tbg name ofthe sub-contraotors and state whether or not those entities have employees. Ifthe,sub-coii�acrors hate employees,13iey must provide their workers'comp.policy zaumbm I am an employer that is p�ovx(Tingworkers'compensation insurance for my employees.'Beloit/is thepolicy acid job site information. Insurance Company _ ✓el YJ IId policy#orSelf-ins.Va.#;Y} . .� 1 _ LJ ?0 Exp at7onDate: � / Job Site Address: JD�l to 5 u city/State/Zip: Attach a copy ofthewa rkexs' compensation p oltcy declaration page(showing the policy x+,um bei and expixa 15 date). Failure to secure coverage as required birder MGL c. 152, §25A is a criminal violation punishable ley'a fmc up to$1,5Q4.40 and/or ono-year vnprisonment,as well as civic.penalties in the form of a STOP STORK ORDER and a fine of up to$250.00 a day against the violator.A,copy of this statement maybe forwarded to the Off ca of Xnvestigat6ns of the D)A for insarauae coverage veriftcation.. X do hereby cer-iify nder the pains andpenalfies ofperjury Haat the informadon provided abo- is true recd cor:ect, Si acute: bate: Phone#: Offacia7 use only Do not-write in this area,to be completed by city or toren offtciaL City or Town: PexrraitlL3cense� lssui ng Anth ority(circle one): i 1.Board of Healti,2.)Buf cling Departrmut 3.City/Tam Cleric` 4.Electrical Inspector 5.Plumbing Mspector b.Other cwltact Person- Phone#: Client#:45591 WICSM CERCATE OF SIF' I IL.ITY I DATE2612DIYYYY, Ira 07126/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOWER.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 liens of such endorsement(s). PRODUCER - NpMEac Ga�IIOnuglas Eaton& Rerube Commercial Line P}tONE 603 $82.2766 11 COnCOrfJ St, A1C No Ext: A/C Nn ED MAIL Nashua,NH 63064 AODRess: , INSURER(S)AFFORDING COVERAGE NAIC 0 „ 603 682-2766 INSURER A,Arch Insurance .INSURED Wicked Smart exteriors INSURER a;AIM Mutual Insurance Company 149 Lund Rd INsuRER c; Nashua, NH 03060 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIL) CLAIMS. LT TYPE OF INSURANCE INSR 0"T POLICY NUMBER MN€/DOtYVYY MM1aDlYlEfXYY LIMITS A GENERAL LIABILITY BINDER295612 712912016 07/2912017 EACH OCCURRENCE $1,000.000 X COMMERCIAL GENERAL LIABILITY DAA'IA RENTED PREM s Ea.un $100 000 CLAIMS-MADE ®OCCUR MED EXP(Any one,person) $10,000 X BIIPD Ded:1 000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 xPOLICY n JECT LOC $ AUTOMOBILE LIABILRY GOMSINED SINGLE LIMJT Ea accident ANY AUTO - BODILY INJURY(Per person). $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per acddent) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS APer acc dent UMBRELLA LIAB OCCUR £ACH OCCURRENCE S EXCESS LIAB Id CLAIMS-MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION AWC4007029342 7/23/2016 071231201 }� We STATU- I IO1H- AND EMPLOYERS'LIABILITY _ ANY PROPRIETORlPARTNER(EXECUTNE Y 1 N E.L.EACH ACCIDENT $100,00® OFFICEWMEMBER EXCLUDED? ® N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 000 It yes,describe under DESCRIPTION OF OPERATIONS below EA.DISEASE-POLICY LIMlT $100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES(Attach ACORO 10i,Addltlanal Remarks Schedule,If more space is required) Workers Comp-MA Proprietor Excluded: Ryan Dolan,towner CERTIFICATE HOLDER CANCELLATION / FOR INFORMATIONAL PURPOSES ONLY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE -THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, r AUTHORIZED REPRESENTATIVE { CORQORATION.All right'-reserve CORD GDX The ACOF2D name and logo are registered marks of A ® DATE(MMMD/VYYY) CERTIFICATE OF LIABILITY INSURANCE 8/1912016 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 poticy(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 endorsements. PRODUCER NAME; Eaton&Berube Insurance Agency, Inc. PHONE (AJC. 0.Exi&03-882-2766 A1C Na. 11 Concord StEMAIL Nashua NH 03064 ADDREss. INSURERS AFFORDING COVERAGE NAIL N INSURER A: INSURED WICSM INSURER 0: Wicked Smart Exteriors INSURER C: 149 Lund fid INSURER 0: Nashua NH 03060 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:182301568 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. INSRAtlDL SUER POLICY EFF POLICY.rzXP LIMITS LTR TYPE OF INSURANCE INSR D POLICY NUMBER (MMIDR= JftMPD1YyM A GENERAL LIABILITY 295512 7/29/2016 7/29/2017 EACH OCCURRENCE $1,000,000 DA TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100.000 CLAIMS-MADE OCCUR MED EXP An one peeson) $10,000 X 1,000 PERSONAL&ADV INJURY $1,()00,0 0 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 X POLICY 0 PRO, LOC $ AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDRETENTION$ $ WORKERS COMPENSATION WC STATU- I IOTH- AND EMPLOYERS'LIABILITY ANY PROPRiETORIPARTNEPJEXECUTIVE Y, EA_EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Y NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE..$ It yas,describe under US, OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) i CERTIFICATE HOLDER CANCELLATION l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE r O 1968-2010 ACORD CORPORATION. All rights reserved,:': o ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i d r r - ensee Details . . c Information Full Name: RYAN DOLAN ion er Name: Nashua State: NH Zipcode: 03060 a nt - U '#ed #ates License Na: CSSL-106038 License Type: CSSL-RF-:.Roofing Profession: Building Licenses Date of Last Renewal: 8�13I2018 issue Dat+v: Expiration Date; 8122!2016 License Status: Active Today's Date: Secondary License Type: Doing Business As: on Vtu;sr e r e q u i s h License i uance Chan e R as Licensee: DOLAN, RYAN Relationship: Attrifaute Of '.....:•ti4x License No: CSSL-106038 close window ._ 02011 Commonwealth of Massachusetts - Site Policies Contact Us u ;i1 >.i <:5 G.� �E))s 8122/16,6:29 AM ency_id=l8:iicens�id=79825 http://elicense.chs.state.ma.usiverification]Details.aspx?ag7& Page 1 of 1 �.n:ra.aaas.aapaa�l 090£0 WN 'V(1HS`!N CRA GNn"I 6176 N` -10C^II �N'd^+AM X. -LF JVVWJ 0.:151+,!11 A 4 V90 MUM aNC11�1e',III.IX qr��" � � "Z,£4;U 6 WoRe.119160 U �� 01-O IlN00.1. MFIAMIdW1"�W01 a�aawleat3a�ss5zarsnt7 7g�"^a4'sJ:IW a�aauasuo7.Iar a:7t4Jt1 "�'„ ,' 1��P`lI1®,7.YlSI'�>77�,?�r7 Y/��JN�IDrI///r71II dAJ r7� SJAJ�', License,n-r+el;istration valid for indiviclnl use only before the exhirrrtioar(late. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116