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Home My WebLink AboutBuilding Permit # 8/31/2016 V � ox 6 @ BUILDING PERMIT � TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION ; ermit "` Date Received Date issued: vo ITS us MPO TAINT: Applicant must complete all items on this page LOCATION �� 51" PROPERTY OMdER ' � Primo MAP NO: PARCEL: '� ZONING DISTRICT, Historic District yes no Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building i::I One family ❑Addition XTwo or more family f::] Industrial ❑Alteration No. of units: ❑ Commercial ;kvRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition 11 Other 0 Septic [] MtM9"ell l::.t Floodplain ' ❑ Wetlands ❑ Watershed District f❑ Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: I 6,cej Phone: C _)ZS' __91 >-I Address: CONTRACTOR Name: Phone- Address: o, 02v Supervisor's Construction License: Exp. Date. Home Improv em nt License: Exp. Date., ARCHITECT/ENGINEER Phone: Address: I 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 Dost: e FEE: $ Check No.: - Receipt No.. 3 ,TOTE: Persons contracting with unregistered contractors da not have access to the guaranty fund Signature of Agent/Owner Signature of ant,!o r .... N®RT1 '4 own of 2 _ b ndover . o � � t No. �Qh ver, Mass, �j l coc.acNtw,c� v1' � 1 p0'4Ai'ED U BOARD OF HEALTH Food/Kitchen PfERMIT T D Septic System THIS CERTIFIES THAT / 1.��..:.... ?o a f., .J � lV a....... BUILDING INSPECTOR r . ...... has permission to erect .......................... buildings on ....7...�..-.fr. ......�'�T.�.��7 ..� Foundation-. 1 Rough tobe occupied ........................................................................ 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONST ION T Rough Service . ... ........ ........... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit.required to Occupy Building 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. Page 2 of 8 r. PROPOSAL Proposal Submitted To Phone: Date: Dan Hill&Dolores DePiano 978-697-9824 8-23-2016 StmetAddress: Salesman: Contact Person: 57-59 Cotuit St Steven Balsavich Dan City,State and Zip CodeEmail: North Andover,MA 01845qsryche9l@yahoo.com We hereby propose to fur>pish labor and mateeials to install new shingle Proof to V}apuf4etttEreir'N specifications by the following; This estimate coverq foe f9gowi ng roof areas: • All Shingle RoofAreas Preparation: • Remove the existing asphalt shingles and felt down to the wood sheathing, • Leave any existing ice and water shield in place, • Cut pt new oi'e g 41 t#p ems#pg sheatlaillg for the new tidgc Vent. r Inspect for and replace any broken,rotted, or missing roof sheathing. Any sheathing replacement cost depends op the type of sheathing. • The building will be U"cd dudog Vc Tmoval process. r Protect all shrubbery as required. Installation: • Install new aluminum drip edge along all rakes • Install vented drip edge on all eaves. • Install Ice&Water Shield 6 feet along the eaves of the roof. • Install Ice&Water Shield 18 inches around all penetrations. • Cover the balance of the roof with Synthetic Felt. • The shingles that will be used are: Owens Corning Your choice of standard manufacturer colors: Customers Choice • Install a new Ridge Vent to be covered with Seal A Ridge shingles at the existing and new ridge openings. • Install new vent pipe flashing up to 4 inches. Any larger will be properly sealed. • Re-use and seal the existing sidewall flashing, dent INUaf i Page 4 of 8 Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Estimated Start Date: Estimated Completion Date: The Start Dates Given Are Weather Dependant And Will Be Decided U on Acceptance Of The Proposal. We propose hereby to furnish materials and labor,complete in accordance with above specifications,far the sumof. Ten Thousand Five Hundred Dollars ($10,500.00) Payment terms are to be as follows: *1/3 Deposit $3,500.00 *113 At Start $3,500.00 *Balance Upon Completion $3,500.00 *Total Pa ments $10,500.00 DO NOT SIGN THIS PROPOSAL IF THERE ARE ANY BLANK SPACES Contractor's Authorized Signature: ��gz Date: d ACCEPTANCE OF PROPOSAL—The above prices,specifications,conditions and additional terms are satisfactory and are hereby accepted. You are authorized tp4Q the work qi specified. 19ayment will be made as outlined abov . LA '7,, ) Date of Acceptance` Signature: Signature De 4 Contract Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute,concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in 7assachulseGeneral Ls, chapter 142A. At Ir 16& ees Signature Contractor's ignature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. tient Tnial W4 The Commonwealth of Massachusetts J Department of Industrial Accidents 4 I Congress Street, Suite 100 Boston, MA 02.114-20.17 www.inass.gov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plunibers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl NaMe (Business/Organization/individual): -�tAcn Address: Eya �- City/State/Zip: CU `d5 Phone#: � 7S- R004, Are you an employer?Check the appropriate boa Type of project(required); 1,F—I t am a cinployer with employees(full and/or part-bane).* 7. ❑New construction 2,Q I aro a sole proprietor or partnership and have no employees working for inc in $, F1 Remodeling any capacity.(No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself,[No workers'comp.insurance required.]a 14 []Building addition R.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensatiun insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.W am a general contractor and t have,hired the subcontractors listed on the attached sheet. 13.DeRoof repairs Thest sub-contractors have employees and have workers'comp.insurance. 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.) *Any applicant that checks box p l must also till out[lie section below showing their walkers'compensation policy infonnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors inust submit a new affidavit indicating such, lContractors that check this box must attnched an additional sheet showing the name or 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 ant an employer that is providing workers'compensation insurance fur illy employees Below is the policy acrd job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 0 Q7,3t3�5 ��•s Expiration Date: II cb 16 Job Site Address: QCp N City/State/Zip: N, � 01�5L15 nil _ Attach a copy of the workers' compensation policy declaration page(showing tate 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$250.40 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(Io hereby certify under thepaurrs and rnalties ofperjnry that the information provided above is true and correct. Si nature: l Date: zD Phone#: f Official use only. Do not write in this area,to be completed by city or town official. City or Torun: 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#: i CERTIFICATE OF LIABILITY INSURANCE06/171 DfDD/YyYY! a5117/216 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(les)must have ADDITIONAL INSURED provisions or 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 GONTA T ISABELE CORDEIRO PRODUCER NAME �..,..,. __..___, .. FAX -..._. .. _,-. ....-_ . .,,. Brazway Insurance _ PHONE , 978^455 5991 978^45S 9934 trl?G.Na kXll. _ _ �IArr,,No! _ 345 Main St Unit B1 I-MAIL brazwayusa(TM phoo,com _ . Tewksburt MA 01876 INSURERiS)AFrORDINGCOVERAGE NAIGN INSURER A;WESTERN WORLD INSUREDD AM CARPENTRY INC INSURER a g THE HARTFORDu _..... ..,, __ ....._ ._ .._... 110 DELMONT AVE.x#11 INSURER G: LOWELL MA 01852 ,INSURERE INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THUS 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. __...-. _PQLICY EFF POLICY EXP— ILTYPE OF INSURANCE ..., AbbLISLIeW POLICY NUMBER MMfDDNY'1'YY MMI_0 NyYYY LIMITS I_TR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 51,OQa,QO DAMAGE TaRtNTED _ CLAIMS-MADEOCCUR PREMISES(Ea,oceunence! S 1aa,aaa ._ .11 A MEQ EXP(Any one person)„ -_ _uw S 5,aaa _.. . NPP8314993 0412812016 04128/2017 V MERsaNAL aADv �uRY s 1,000,000„ w2,000,000 GEN'LAGGREGATI LIMIT APPLIES PER: GENHRAL AGGREGATE 5 PHI- � �PRODUCTs_COMPIOPAGG�$ 2,OOa,aaa LCY JECT LOC $ E[OPOHlr TR; COMBINEDINGLE LIMIT AUTOMOBILE LIABILITYlull (Ea acdden4J _, p$ ANY AUTO BODILY INJURY(Por person) p$ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED (Pear acc em)__G $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACHOCCURRENCE EXCESS LIAR CLAIMS-MAO � I AGGREGATE I: S _ _.. _ DEQ RETENTIONS ��- 6S60UBOG36388515 10/141201510/14/2016 EL EACHACt aTH WORKERS COMPENSATIONLi PFR YIN _ER _ .. _ AND EMPLOYERS'LIABILITY f L.DISEASE_ StATIJTE OrFICE IMEMB RFXC UDE1 EGUTiVE. IFAEMPLOYEE�S 100,000 10 (Mond tory Y �N7A a,aaa B (Mandatory in NM) ._ 1I9 yy®s,describe, E,I„DISEASE-POLICY LIMIT s 500,600 DESCRIPTION N OF aF Or"EftAT10NS below � ---,---"”" iO DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Addlllonal Remarks Schedule,may he attached If more space is required) CARPENTRY,ROOFING,SIDING CE TIFI E HOLDER ." CANCELLATION STELLA CONSTRUCTION&HOME SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 82 PINKERT STS` THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MEDFORD MA 02155 AUTHORIZED REPRESENTATIVE, Ce31988-2015 ACORD CORPORATION. All rights reserved. Stella Construction HIC & CSL License's r or'�rr / �/1 r 1i� r/ / v�y `h'� m r ar�f� r �to ytlU r�1`/ ✓�i 1 �wif, �y r r� 1 i