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Home My WebLink AboutBuilding Permit # 9/29/2016 UILDING PERMIT ... TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONDate Received P, Date Issued: mm- 1 all ite�T�s /„ ✓ ilii. / i, ,,ir ai ,, ., o , rrr / r „ r /, i � �,,, ,/lir r i�: / i / // � ✓/ / /, ,. � r / ,, ////./ / r i ///, / ,, �. .. c/,/% �!, /�/,.// // "" r, /��// /,.,✓ ..,,rrr„ TYPE OF I PROVEMEiiT PROPOSED IJ E residential loan- Residential F1 New Building [D One family El Addition D Two or more family El Industrial 0 alteration No. of units: o Commercial PRepair, replacement U Assessory Bldg [] Others: 0 Demolition I] Other 77-1�1117/ 77 a/i r ,i /: r� //r,,. 2 Identification Please Type or Print Clearly) Name: P ®n : Addres ARC RITE T/E GI NEER Phone: Address: Reg. o. _ FEE SCHED iL :BULDING PERMIT-'-'$12.00 PER$1000'00 OF THETOTAL ESTIMATED COSTSASED $125A00 PER S.F. a� Total Project Cost: --FEE: ..M... h 1 .: � i n� Receipt .: en NOTE: Persons contracting std¢ nnregist red contr tor° dry not have css t � sf t "'O if ill r w ��w & t%ORTk Townof sAndover G 0 No. t)61 3 h C' LAKE h ver, Mass, COC KIC H!WI[K �. Areo � 5 U BOARD OF HEALTH Food/Kitchen PER IT T Septic System THIS CERTIFIES THATmr*.A�. �. BUILDING INSPECTOR has permission to erect .. build on Foundation ................. ..... .. .. 7.................... w � Rough tobe occupied as ................... ..,,.. . ., .�.o ........................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C®NSTRUCTI N T- S 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. 11 Huse.Street 617-590-1064 Lawrence,MA 01841 fel Estimate No: 206 Date: 9126/2016 Mountassir Lalami 16 Harthaway Road North Andover,MA 01845 tf 617 828 9123 I I . Afb+�iftat i fGe � f. tiC)1, — ' -, ��Strip Existing roof down to bare wood T 1.oa $5,zoo.00`' -$5, 00.00 if there are rotten wood,wood will be replaced up 50 ft.at no additional cost Supply and install 8"White Drip Edge to perimeter roof Supply and install 6' Grace Ice&Water Shield Supply and install Underlayment Synthetic Paper to entire roof Supply and install Timberland Architectual Shingles Supply and install Ridge Cup shingles Supply and install aluminum Roof Flashing to all exhaust pipes Supply and install Lead flashing around chimney Supply and install Step flashing around chimney Removal of debris from property, dumpster truck to be used. 'I ndickites non-taxable item Subtotal $5,200.00 Tax(0.00%) $0.00 Total $5,200.00 Page 1 or i the Commonwealth of.Massachusetts Department af.IndustrialAceidents 1 Congpess Street,Suite 100 M V - a .goston,AflA 021.1412017 K www.mass.gov/dia sv+ Wu kers'CornFen U�3k )CInsurance Lu7 n i IIx] e Ri leAx GNffi(0Rl trzexans7l?b a ers. !leaseplint Tae IN ''licant In formation W + m ,r Na,mG(BusinessfOigan ai7,on/Sndividual); QUq City/state/Zip - — Type ofproject( equired Are you an emplo `?Check the appropriate b=.yer7. �I i�TeW'constriibi]on ith ,�-:.-✓ employees(ftz11 anrllax parE titne).� L- I 1, r I ora a arnploycx w g, LI (�.en7 o Clel79?g 2. 1 are.a sale proprietor or partnersbip and have no employees fro' ing fbz me aisr 9_ ernrrlitiori any capacity.[No workers'comp.insurance required.] ell Noworkers'comp.iasurancerequired.j t l0 CI Building addition 1 am a homeowner doing all wor_Myself, my' i L Q.�I am a homeowner and will be hiring caafractors to conduct all work an my property. 1 will 16� I l leQ-Tic l r i>,1Y S o7 dtlitions ensure that all contractors gither havo-,,kers'compensation insurance or are sole l22�Plum ling repairs Or additions proprictors with no emplcyc6s. l0, 466fre&iril 5.� or 1 am a generalniractozs haveseinplayees andave arks s,cosmlptinwranced on e attached sheet. lhesesub s,a 14.n0thwx;,__.-- ptiou er f I= 6.1`�Weare a oo[poratianandits,of ceieehav works camp nerGISed their right ourance required.] MGL c. — ! 152,§i(4),and wva have zsa employ the1 workers'compensation policy informatiom, *Any applicant that check baic fit,yxsust also ll arit the section bele--work all Pd.thcu-hire outside I Iiaxneownexs who submit thss ai"tidavit inded an a doing the name of the sub�antractaros and statg wh theraor not fhosew affidavit ment fists havo hi $Coutractoys that cbeckilliq must attached olio number. — •. employees. Ifthe sub-contractors have employees,they must provide thea' workers'_� cc>mP•Ply X n employer tFirxt ispra-VIdIngwor7cers'compensation insurancefor rrty employees, $elves is tFiepaliry enol job site information. f'y`tY 9 ( _ Insurance,Company, ams _ _ Datet ,.( 2r Policy#or Self iris.Lic.#: _- . _ xpiration � �� _City/State/Zile: _ Job SiteAddxess: _ a co aftlxe'vvoxl ers'compe?�sa� Pokey declara-ti0nPage(slzov�ingPolicy tbLe shabtoby afiA-up to$1Wer and ,,500. 0 A,ttacb. P5' Failure to secu e coverage as rcquired under MOL 0.:152,§25A is a criminal-ViolationP as-well as civil penalties in the forirr of a STOP WORX-ORD�k�and a kine of UP to $250.00 a Of this statera.ent may be forwarded to the Offtcc of Investigations of the RIA f and/ax one-year imprisonment' or insurance day against the violator.A COPS _ coverage-Verification- _ _ _ _— nalties of perjury trzat 17ae information,�rovicleci a vve is true ani corAr r ~X clo F- leh certi �fJ•ie ai ncip Date', Signature -- I'l�.oxte ,oral, [6. ficial use only. Ica rxotlpl^ite ire this area,to be carrrpleterF by city yr town off perinii:FLicenso ty or Tawn: — tung Authority(circle on.e); J_Board of I'iealth z.73uilding Department 3.City/':['own Cleric d.Slalectrical I'nsPectar 5.k'lurnl7ing Isasp�ectox Other _�.____.__—_.____----.____._ Phoneoxitact:F'exsoxa:_�__._.___.._�._.._ GUTIERV103 DKULICK DATE(MMIDDIYYYY) �'►�� CERTIFICATE OF LIABILITY INSURANCE 9/2812016 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 1NSURER(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 endorsements). CONTACT PRODUCER License#1780862 NAME:__..._.... �—.. HUB International New England PHONE 657-5100 — — FAX (976)988 0038 ._L.N�e,?n):(978) - - 299 Ballardvale Street E-MAIL Wilmington,MA 01887 INSURERS}AFFORDING COVERAGE NAIC p INSURERA:Penn-Amertca Insurance Company 32859 INSURED INSURER B: Victor GutierrezdbaVictorRoofingExperts INSURER C — dba Victor Roofing Experts INSURERDJ,,__ - 11 Huse Street 1 INSURER Lawrence,MA 01841 — INSURERF COVERAGES CERTIFICATE NUMBER: 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, —.--_ .. _ _.—_ -[' F' Xi' ._—. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. QEICY E?Ff POLICY E S.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ LlMlrs INSR 'TYPE OF INSURANCE I IN p yy1IDBRI POLICY NUMaER MMfpD1YYY i MMIDD 1,000,00 A X.COMMERCIAL GENERAL LIABILITY 1010612015 i 1010612015 E EACH OCCURRENCE $ I '"DAMAGE-TORENTEiS C j(� PAC7097591 PREMISES{Ea occnrren - $_ __9,000 CLAIMS-MADE OCCUR F MED EXP{Any one person} $ 5,000 1,000,00 PERSONAL&ADV INJURY_ . _J_.—._�.. ._ _._ E 21}00 00 r GENERAL AGGR€_GATE_ $ i I GEN I_AGGREGATE LIMITAPPLIES PER' �2,000,QQ r_�PRO LOC 1 j 9 ROIIUCTS-COMPIOPAGG POLICY L i JECT �,� ! - ---�' !$ € OTHER; COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY �eccidenn� --- `BODILYINJURY(Perpersar,) i$ ANY AUTO _.—..��.—...�-— — ALL OWNED F__]SCHEDULED ! !,BODILY INJURY{Per accident),$ -�AUTOSAUTOS i PROPERTY DAMAGE !$ F_��NON-OWNED ' l f �[Peracddent} ,,, _! HIRED AUTOS �d AUTOS i OCCURRENCE UMBRELLA LIAB _ OCCUR i j EACH $ - —'— —' EXCESS LIAB CLAIMS-MADE ! !AGGREGATE !$ .. ..� ., DED RETENTION$ ; I PER OTH- WORKERS COMPENSATION j E ,STATUTE _i�1? AND EMPLOYERS'LIABILITY Y I N Il I E.L.FACH ACCIDENT_ ANY PROPRIETOWPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? �iN1A! E.L.DISEASE-_EA EMPL_OYE5'$ (Mandatory in NH) I - - It yes,describe under i !E.L.0{SEASE-POLICY LIMIT_L$_ DESCRIPTION OF OPERATIONS below �I V �I I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 161,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mountassir Lalaml ACCORDANCE WITH THE POLICY PROVISIONS. 16 Harkaway Road North Andover,MA 01845 AUTHORIZED REPRESENTATIVE /CO 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE UATE(MMft)DIWYY) A�U 09128!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(iss)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 NAME: Diane Kulick AX HUB INTERNATIONAL NEW ENGLAND LLC �C E�1; (781)792-3238 Not: ��M AIL ADDRESS: diane.kulick@hubinternational.com 600 LONGsWATER DRIVE INSURER(S)AFFORDING COVERAGE NAIC# NORWELL MA 02061 INSURERA: TRAVELLERS INDEMNITY GOOF AMERICA 25666 INSURED INSURER B: _ GUTIERREZ VICTOR DBA VICTOR ROOFING EXPERTS INSURaRC: INSURER D 11 HUSE STREET IN5URERE: LAWRENCE MA 01841 INSURER F: COVERAGES CERTIFICATE NUMBER: 89204 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 SUER POLICYNUMBER POLICY EFF POLICY EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ CLAIMS-MADE OCCUR PREMISES AMAGSEa o�rrence $ MED EXP(Any one person) $ NIA PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY L]PRO- LOC JECT __...PRODUCTS-COMPIOPAGG — OTRER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acGdenl ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED NIA BODILY INJURY(Per acc€denl) $ AUTOS NON-AUTOOWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS _ ,, -- UMBRELLALIAB OCCUR EACH OCCURRENCE $ — EXCESS LIAR HCLAIMS-MADE NIA AGGREGATE $ DEO I RETENTION$ WORKERS COMPENSATION X STATUTE I i ERH AND EMPLOYERS'LIABILITY ----- ANYPROPRIETORIPARTNERIEXECUTIVE Y1 N E,L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDEI NfA NIA NIA 6HUB6B12804616 07/20/2016 07120/2017 "- (MandaloryinNH) E.L.DISEASE-FA EMPLOYEE $ 100,000 If yas,describe under DESCRIPTION OF OPERATIONS below EL.DOFASE-POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES(ACORD 101,Addltlonat Remarks Schedule,maybe 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 autharizattan 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.masr,,govilwd/workers-compensationlinvestigationsf. Sale proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mountassir Lalami ACCORDANCE WITH THE POLICY PROVISIONS. 16 Harkaway Road AUTHORIZED REPRESENTATIVE North Andover MA 01845 n`el C Daniel M.Cro ey,CPCU,Vice President—Residual Market—WCRIBMA p 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Construction Supervisor Restricted to: Unrestricted-Buildings of any use group w4►ich contain less than 35,000 cubic feet 4991 cubic meters)of enclosed space. A f=ailure to possess a current edition of the Massachusetts State Building Code is cause for revocation'of this license. OPS Licensing infomnationvisit.WWW.MASS.GOVIDPS St CS-077184'. MAXINOS HATZLILIAUES 5 MADISON STREET BELMONT MA 02478 Coll,alissio mer 0912912017 e ob ,,Office of Consumer Affairs&Business Regulation �a ��TOME IMPROVEMENT CONTRACTOR �r loegistration: 176451 Typo: xpir^ation: 0/23/2017 Individual VICTOR X.GUTIERRE VICTOR GUTIERREZ 11 HUSE ST LAWRENCE,MA 01041 Undersecretary i i f I 1 License or registration valid for individul use only before the expiration date, if found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 51.70 Boston,MA 02116 --.. --Not valid without signature