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HomeMy WebLinkAboutBuilding Permit # 8/30/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PermitNO: Date Received 12,k U Date Issued: 1 A IMPOIITANT �icanust co! Ictc ll rtems on this -7 77,77,77,771171, 77,7777 -9- ,40CATION, 9 ,Z TYPE OF IMPROVEMENT PROPOSED USE Peri ontial Non- Residential r_1 New Building 1".Vbne family 1-1 Addition ri Two or more family Cl Industrial ri Oteration No. of units: 11 Commercial ,Vrepair, replacement F1 Assessory Bldg Li Others: [-..I Demolition Other 7( 777, 7' 57W LW Nw AP Identification Please Type or Print Clearly) OWNER: Narne- Phon Address: /77 T; L�e 00,0;r p 50 IV ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -FEE: $ Check No.: C Receipt No.: NOTE: Persons contracting with unre islered contractors do not have access to the guaranty fund Signat6re,ofAdent/Owner ftnature of contracior t%ORTFI S Town of :, _ ,t. 6 ndover 0 y.. 0% 14-M-0 No. ��� i�d1 - h ro ! h ver, Mass, CCC MICMI wItK V �7,qA°RArFv S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...! `. ..�. .. ......... L441 ,......... ... BUILDING INSPECTOR has permission to erect buildings on6. '( Foundation .. ��j'J�.. .... . .R, .,........ Rough to be occupied as .e�`�'`�"!�''` ............................................................. Chimney provided that the person accepting this ermit 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 C®NSTR I®N Rough Service .. .. . .,.. . ..... .......... ........ ..... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit.required to Occupy 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. I �I Craig LaCrosse-owner CONTRACT PO Box 728,Tyngsboro NIA 01879 August 31, 2016 975-SRO-7376 cmig@roofingkinginc.com Customer: Satish Tkalapialli Address: 21.Peterson Rd,{forth Andover MA Postal Code,01845 Phone: 508-329-4713 Email. tsatishchandra@gmaii.com Thank you for allowing Roofing King Inc.the opportunity to work with you. dere is a list of the work to be completed,the agreed price and payment structure. Please feel free to contact me with any questions or concerns at the number listed above. SCOPE OF WORK: Full roof replacement: -House will be covered with roofing blankets to prevent any damage and for easy cleanup -Remove all shingles right down to existing wood and re-nail and prep before installation process begins -install up to 96sq ft of rotted plywood(3 sheets 1/2 roof plywood)at no charge on any full roof replacement&$50 per additional sheet if needed -Install 6 ft of GAF Storm Guard ice and water shield leak barrier along base of roof and areas listed below -Cover all valleys,snow load areas,under all flashings,wrap all penetrations including but not.limited to chimney's and sky lights -Remove and re-install new plumbing flashing on soil pipes vented through the roof -Install Felt Buster on any exposed wood before shingles are applied -Install new 8" (color)drip edge on all edges of roof for proper protection -install GAF Pro Start starter strips around entire perimeter of the roof to create a 1/2 inch overhang for proper install -Install GAF Architectural Timberline HD LIFETIME Ltd.Shingles will be storm mailed with 6 mails per shingle 134 MPH resistance -Cut 11/2 inch opening on peak of roof if it wasn't previously done for proper installation to meet building code(on full replacements) -Remove old lead around chimney and reinstall 12 inch lead and reseal joints(if applicable) -Install Cobra exhaust vent on peak of roof to allow proper ventilation and meet building code -Hand nail Seal A. Ridge caps on peak of roof with 2 inch nails to complete installation.. -Blow off entire roof,driveway and all walking surfaces and clean any loose nails with ft rolling magnets daily or on completion -Existing roof will be removed and recycled at Roof Top Recycling(Certified Green Roofer) Job Specifies and Up-grades (on full roof replacements) Weather watch upgraded to Storm Guard Ice and Water Shield $0.00 Included -Remove skylight flashing kits to install ice and water on all 4 sides(reinstall existing kits) $0.00 included -Deck Armor in place of Felt Duster $250.00 Not included Warranty Roof comes with 50 Year Weather Stopper System Plus LTD manufactures warranty Promotions Military,Veterans and Retirees receive a$250 Rebate through GAF when purchasing a GAF Lifetime Roofing System. PAYMENTSTRUCTURE: This price includes labor,material,trash removal,building permit if required and contract may act as signature for permit, (Any additional work will require separate pricing) Make all checks payable to Roofing King Inc. Total: $5,000.00-$500 Act Fast Coupon(Exp.8131) $7,500.00 Deposit(due at signing): (113) $2,600.00 20n Payment(due when material is onsite): $0.00 Final payment(due upon job co letion): (213) $5,000.00 SHINGLE COLOR: initial: ACCEPTANCE OP PROPOSAL.The included specifications and conditions are satisfactory and are hereby accepted.You are authorized to dp the work as specified. Payment eAli he made as outt€ned above and accept all terms included.All discounts on all work to he done must be presented to Roofing King Inc.representative before contract is accepted. If rotted woad is discovered AFTER removing the existing roof,or it could not be Identified at the time of sale an additional charge of$50 per sheet. If this account is collected through legal actions,customerwill be responsible for all attorney tee d courtrosts. ois sure: stomer responsible to cover any valuable items in the attic to protect from debris.Roofing King does not assume responsibility for acts of Mother Nature. r Owner/Cantracto Prope v Owner Craig LaCrosse Satish Takalapaili .... The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,.IIIA 02.114-2017 H www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTIIORITV. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Roofing King Inc Address:PO Rax 728 City/State/Zip:Tyngsboro MA, 01879 Phone##: 978-580-7376 Are you an employer?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. El Demolition 3.®I an,a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4,[:]lam a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.®Electrical repairs or add'it'ions proprietors with no employees. 12.E]plumbing repairs or additions 5Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13,Z Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.®We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Uthet' 152,§1(4),and we have no employees.[No workers'camp.insurance required.] IL *Any applicant that checks box lit must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-contractors have employees,they must provide their workers'comp.policy number. I amt an employer that is providing workers'compensation insurance for rtty employees. Below is the policy aced job site information. Insurance Company Name:Star Policy#or Self-ins.Lie.#:WC 0742797_____ ___------.._----- _._.--_-._-- Expiration Date:08/20/16 Job Site Address: City/State/Lip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c, 152,§25A 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sianature: CI" � .)�, " Date: Phone#:978-580-7376 Official use only. Do not write in this area,to be completer/by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building,Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MMlDD1YYYY) , sm- R CERTIFICATE OF LIABILITY INSURANCE 2/10/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polley(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER NAME: McSweeney&Ricci Insurance Agency, Inc. a"rc°N a Ext);781-848-8600 Alt No. 1$g $$D7 420 Washington Street EMAIL Braintree MA 02185ADDREss: ri om INSURER{S�FPORDING COVERAGE MAIC 4 INSURER A:Berkley..Regional.Insuranc-e Com 29580 INSURED ROOFK-1 LINSURERB:Nationalr M i 4 $Roofing King Inc C:S ar u ante aCraig LaCrosse D:P.O. Box 728 Tyngsboro MA 01879 E:: COVERAGES CERTIFICATE NUMBER:680795776 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. WSR ADDL BR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MWDDQ= (MWDDNYYYI LIMITS A GENERAL LIABILITY CGLOOSS562 12/1112015 1221112016 EACH OCCURRENCE $1,000,000 X DAMA E T E T° CGMMERC€AL GENERAL LIABILITY PREMISES Ea occurrencey $100,004_ CLAIMS-MADErx OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,400 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY PREoi L1 LOC $ B AUTOMOBILE LIABILITY M1T5776F 8/20/2015 6/2012017 GUMBINE Ea accident) $1.000.000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ X HIJTOS RED AUTOS X AUTOS POPE DAMAGE $ AUTOS A UMBRELLA LIAB X OCCUR OU0071022 12/11/2015 12/11/2016 EACH OCCURRENCE $1,000,000 EXCESS L1AB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ C WORKERS COMPENSATION WC0742797 8/20/2015 8/20/2017 X WC STATU- EIH- AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE❑ E.L.EACH ACCtOENT $500,000 OFFICERIMEMBER EXCLUDED? N N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Roofing. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD %IN 1 (9/a-6) " ME Office of Consumer Affairs and Business Regulation 10 Parr Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registratic n Registration: 173117 Type: Private Corporation Expiration: 9/4/2018 rft 290665 ROOFING KING INC. CRAIG LACROSSE a P.O. BOX 728 _ __ .__w._ .. TYNGSBORO, MA 01879 Update Address and return card.Marls reason for change. sc91 a�20M-05/1fAddress ( ,Renewal [-I Employment (J Lost Card .:,r , Massachusetts Department of Public Safety Board of Building Regulations and Standai-ds, License: CSFA-101415 � Construction n Suuiacarvdso 1 & 2 �> CRAIG A LACROSSE 18 HIGHLAND STREET TYNGSBORO MA 01879 'Po"uz l i"w. - Expiratibn: Commissioner 00126/2618 r r f r {