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HomeMy WebLinkAboutBuilding Permit # 10/11/2016 NoarH BUILDING PERMIT TOWN OF NORTH ANDOVER 0 ^ - APPLICATION FOR PLAN EXAMINATION d" Date Received /'6,,w. _ X016 po"Arco nep�P5 Permit No#: �� °RCHUSrc Date Issued. e /1 -0 _.. IMPClRTA1wdT: A plicant.must conn lete all items anrthis >/. �� � //r/. � r„ r., /,� ,.,o ... � /r � ✓ r / it � / / / , .r //r ✓/ 1, / .P l ,r r,r , / ,�, / /�// /, TYPE OF IMPROVEMENT PROPOSED USE ion- Residential Residential _ _ — - Ei New Building ne family Addition ❑Two or more family F1 Industrial FJ Alteration No. of units: ❑ Commercial Ethers: __ ❑ Repair, replacement ❑Assessory Bldg „ :mp ❑ Demolition ❑ Other / etlar7ds „rr r,Waterhed D�str ct lain,-, ;�?.AIV /: r �/..r�/ /i ///% o%,�,r� o ❑,Floe)pI, /i // %/// r/ :/i Se t1r ❑r r „,r, / . r%/r /i �,� i a;mater/ We DESC,R TION OF WORK TO BE PERFORMED: ti - lease Type or Print CI rly . � Phone: , OWNER; Name: C. Address rr rr ,Phone r / r r r ri C��tractor,Naune - /r' r // �. /i/ r r,,, G ;, ,, o ;,,r; „, r rrr/ irr / i �!/il//i, ////�%%/%/,fir/�//�i/r////%//%��a/�.✓%a'; r r,;, ,r, >o, ' s, � �::✓/ / ap, ri rr rr/ pl////i///r / /i r. /r rel rl/i /r/'O%i p/i/%/�,{.. sots C�Jnstrutlor� , � ,...„r/ ra,,,, i�„ ,/,,,,,, ✓i, r r/i',, / r%i r. r/ .✓. / /%i.�// / ..� r /// /,i mss,. �•/r/ / .. ,r r, r,�,l/,a,< ,,, .,<,,,, ,,,,,,,,,, ,,, i ,: ,,,rii,. //i r,��r,,,ii r / r ...rir //.. r �..,a //� r „r�iry vi ;,„,,, ///l/r':✓r //rir r / .,,/ rr r �CDt men 1CeTlse /�. ARCHITECT/ENGINEER 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: , f. FEE: $ Check No.: �L Receipt No.: t 'x NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of contractor Signature ofwAgent/Qwner FORTH owe. of � bAndover O No. 3siwo%li 'Y C% Mass,LAKE h ver, Mass, lo • L OLMIC KE W!C K �. A°aArJEo 1pR,`�(5 S u BOARD OF HEALTH Food/Kitchen PERMIT . L D Septic System THIS CERTIFIES THAT .............M.14146 ..*.;..............C.0 rIV ........... . . ...... BUILDING INSPECTOR has permission to erect .......................... buildings on ........ $��........ ��...�...�.✓.�.........sr. Foundation Rough to be occupied as ...........71f rLIP.........`..............4. .........VIMF............................................ 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 Forth Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough g Final PERMIT XI MONTHS 1 S ELECTRICAL INSPECTOR LESS C CTIA ARTS 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. EXPRESS ROOFING PROPOSAL DATE OF PROPOSAL- ESTABLISHED 1985 — �1�, ou.usyRoma pah■urs P.O.Bex542, aelmsor EXPRESS ROOFINGt P.O.f34x ri42,Chelmsford,INA 0251- Qaaality Yeas Can tL"ook Ups y-p Phone:978.2501-23331 Fax:978.251-2907 wvww.expressrOofer.Com PROPOSAL.SUBMITTEo TO: CONSTRUCTION SUPERVISOR LICENCE 099497 ' AC HOME IMPROVEMENT CONTRACTORS LICEN$9 410312e { tVDR7fi!NP R;M A 01046 978.618wa�914 Wa horoby propose to Armish materials and porforar the tabor noeessaay for the completion of.. STRIP ALL ASPHALT SHINGLES OFF HOUSE AND GARAGE ROOFS CLEAN UP AND HAUL AWAY TAR HQU TQ HELP PRE NT DAMAGE TO NOUS ND INN AREA -COMPLETELY DE-NAIL OLE!ROOFING NAIL AND RE-NAIL ROOFING D ARDS AS N DED WIT 8D RINE SHANK NAILS ALL WAL FLASI-IIN WILL BE INSPECTED AND REPLACED AS NEEDED Install: IKO Storm Shield 6 FE u fI the bottom eaves IKO arm Shield under chirnne lead and down on root IKO Storm Shield arounds ghfa IKO Storm Shield in valle s RHINORQq YNTHETIC ROOFING UNDE LAYMENT over roof boards IKO Storm Shield on roof w ere roof uts Into walls IKO Leading Ede Plus Starter strip on all roof decking ed es IKO DYNASTY Architectural shin les a install 6 nal s er shin le for a 130 fn h IKO wand warren Cutin 1 1/2"a enin on peak of roof and install Roof aver rida vent cion all ridge surfaces All ridg, vent Is Hand Nailed IKO rid a ca shin les all Outside roofed es white New i an es aver vent es 4" All shingles will be astened usin 1 ';"- 1 'fa"roofi nails BLOW OFF ENTIRE.ROOF AND CLEAN G_UTTEFMAND DOWNISPOUTS ROLL 3 FOO AGNETS OUT T PI K NAILS LAWN AREA FOR rINTE CLEANUP ` INCLUDES: ALL LABOR AND MATERIALS FOR THE ABOVE ALL ROOFING PERMITS ARE INCLUDED ALL ROOFING MATERIALS STRIPPED OFA'YOUR ROOF WILL BE RECYCLED AT ROOF TOP RECYCLING 1 r O NN , r 0 Noy-oll 1 • w w , CLEAN UP AND HAUL AWAY ALL SHINGLES Arpre:NU v:anaaty on pnrbems and/or dkrnrrrad cpusod by ice heel Ops No wwronty on dV skyV,bn; All maternal is guaranteodto be as specilfad,and the work to be performed in accordance with the drawings and speclfica tions submitted for above work and completed in a substantial workmanlike manner for the srmr of: 424s O QNS 82� It NO 0JVEY,00WN$ PAYMENTIN FULL,AT COMPLETION OF JOB WITH CASH OR BANK CHECK MADE OUT W THE NAME OF Express Roofing INC. Cas Toll Free %,✓r''" ''1- Respectfully submitted -- BB B, 1-888-210-ROOF ••• "a-rraeproposd may be wiVWrrrrn bi us If not aaepW by: 9124/2016 AN workers fully insure " ACCEPTANCE OF PROPOSAL The above prices,spacilicatioms and conditions are satisfactory and are hereby accepted, You are authorized to do Ute work as specified. Payments will be made as outlined above.Any additionai work than the above will be an extra charge, UPGRADE TO OWE NS CORNING DURATION ARCHITECURAL SHINGLES WITH"SURE NAIL PATENTED TECHNOLOGY" INCLUDES A LIMITED SO YEAR NON-PRORATED COVERAGE ON MATERIALS AND LABOR OWENS CORNING SYSTEM ADVANTAGE WA ANTY S FULLY ANSFERAIBLE slgrtature DaiecXsr SHINGLE OLOR Homeowner i espo fble for protecting and cleaning content orae c from possibl dust and debris 7__ durrn_ofi r rofert III*(aespoasibiofor any issues eausedby anon? Any 112 in,Plywood installation for roof will be an additional charge or sso.eo per heel Labor and materials No warranty on old skylights We recommend old skylights to be replaced with Velux skylights for an extra charge We recommend new chimney lead with all now roofs for an extra charge of$595.00 per chimney OJI l'd slaald e19101­100 eced B90:6091, l,Z d9S ' Na DATE(MMIDWY-YYY1 ACC>RL> CERTIFICATE OF LIABILITY INSUMNCE 0612412016 THIS CERTIFICATE IS ISSUED AS A MATTER CIF INFOliMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE: COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sy. AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must bra endorsed. If SUBROGATION IS WAVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorssemen4a). PRODUCER f€gMEh_ANDRE SILVA_ '. RAPO&JEPSCN IN$URANCE SERVICES INC P€ioNu ,.rya! IAI ...I ,.�au. X09�7a5.6r� __ _ ---- -. aft& 2t3��_.._._._.._ 191 CONCORD ST F.MAIL _- FRAMINGHAM MA 01702 _r y INSLIRf¢�ISAPPDRGINc caveaa ___...___. _ �—. rtAIC a _ INSuIiERA: >~Ni7UiANCEIN�URANCECa INSUR41D INSURERq l.lt3ERTYMUTUAL.INSURANCE_CsJ_ VIVE STAR GENERAL CONSTRUCTION CORP - 153 ARLINGTON ST APT 2 FRAMINGHAM MA 01702 kNsusBRn;,,._,:. :_ _. M,_ r_. _.,_,._:___ ------ JN --__. _ ENSURERf: COVERACE$ GERTIFICATB NUMBER, REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE tISfE?C1 ESELOW€iAVG fsltEN ISSUED TO THE INiSIlIiE D'NAMED ASpVE FDR THE POLICY P R100 INDICATED. NOTWITHSTAND]NG ANY REQUIREMENT. TERM OR CONDITION OF ANY CIDWRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CFR'rIFICATF MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE APPORDGD BY THE POLICIES DESCRI13ED HEREIN IS SUBJECT TO ALL THEE TERMS, EXCLUSIONS AND CONDITIONS Gir SUCH POLICIES:LIMITS$HOWN MAY HAVE 6f I-N REt7UC£D BY PATI?CLAIM. AnnEEIt1R ..— PCI.ICYEPF —HOLIv FaiP0. INS1§ .._....TYAE OF InISURANCE I aLICY NU€ADER EiHM113DJYYYY M!D LIMITS GENERALLIABILITYI I •EACHOCCURRENCE f S 1,E700, L1I3_--• X i COMMERCIAL OPKPALUA0IUrY !�""" I _PREhkis --aa-trrencaE_.�.?_��.Q,Q�Q_-- CLMMS-MADEII OCCUR MED EXP(Ant tlna Parjan) L._._ A GBG20001273700 104/0612016 0410612017PERSONAL&Arlo INJ s 1,000?�Oi i3. GEt%IERALAGGREGAT€ E S2,000,000 GCN'LAGGREGATEL€MIT APPLIES PER PRODUCTS COMPIOpAGG POLICY, � S I I LOC, I --�- s AUTaM091Lk LIABILITYF- '` I(ER aOlNCO C ja L I j 9__------._ ANY AUTO i i 800I4Y INJURY(Per parson) 3 AU­OWNED f ;SCHEDULED BODILY INJURY(Par accidenll15 AUTOS I_--!AUTOS hlt�>Ii7YDAhiAci NON OWN vEq HIRE€IAUYOSAUTOS I ! �,(9erRui�lsnlf _.. -,_.,.__.!S__-.__. .. I � Uh€f3RE?LLA L€AD OCUR`' ^.^—'.. .. . CUR II £ACHO4CURRENCG I S —,_�._—.- ._ .., EXCESS LIRIS CLARASWADE AGGREGATE_ S OED _ ,RETENTIONS S WORKERS COMPBYSATION - .._.. - ..,,� .�•�- ^-••••- - YYC Igo- AND CMPLOYERV LIAWLITY 3L-ANDC•MPLOYERS'LIABILITY YIN . ANY PRQNRIETOMPARTNENEXECUTEVC I E L.EAChE ACCIDENT 15 S aFFlcf:Mt Dn13Eft EXCLUClEF)9 I N I,Nr A I WC2-31"0115d•(l36 Obf2912016 O1i12112t?17 _._. IldaaJa€ary in NN) L_— I �C L..DtSEASC E_1 EM€'I()YE S 1 zI�OUgQ ..... S Ir yes.d®aC(iha Under - E.L DISEASE-POLICYLIMiT S 1,ROO,U00 I I I)9g0RIPTS0N of OPERATIONS I LOr,ATIONS 1 VE141CLES EAnacn ACCIR0 sob,A00lenol RA(VIOrkv Sclt,sc[ula,It MON aptag It rsqulr,ed) CERTIFICATE HOLDER CANCRLLATION t C EXPRESS ROOFING SHOULD ANY OF THE ABOVE DE$yRE3ED PO :i FORE THE EXPIRATION DATE THE EOF, NOTIC £ D {aRfT0 IN 16 JONAS RD N ACCORDANCE WITH THE PQLIC PROVISIONS: i WESTFORD MA 01886 AUrii6RIrEG REPRESENTATIVE (01988-2014 ACOR15ZIORPORATION. All rights res ed. ACORD 25(2010105) The ACORD noMe and logo are registered marks of ACORP The Commonwealth of Massachusetts Department of Industrial Accidents 'fl Office of Investigations 600 Washington Street r: Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Elepcleea5e Print Le ibl �►, licant Information Name (13usiness/organization/Individua1): CA Address: i Phone#:_ — City/State/Zip: Type of project(required): Are you an employer? Check the appropriate box 4, I""ant a general contractor acid I 6 M New construction l,❑ I am a employer with_ — have hired the sub-contractors 7 Remodeling employees (full and/or part-time).* listed on the attached sheet. 2.❑ 1 am a sole proprietor or,partner- These sub-contractors have, 8. M Demolition ship and have no emploees employees and have workers' 9. ❑ Building addition working for me in any capacity. comp, insurance.# [No workers' camp.Insurance 5 We are a corporation and its 10.©1 Electrical repairs or additions required.] officers have exercised their I1.❑Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I2,[ f'oof repairs myself. [No workers' comp. c. 152, §1(4)a and we have no insurance required.]t employees,,No workers' 13T] other �___---- comp.insurance required.] pensation icy *Any applicant that checks box#1 aust vitauasdicat3ngttheythe sar td doing all work aion below nd then hire outside g their workers' contracts s must submitfan w affidavit indicating such, t Homeowners who submit this affidavit tContractors that check this box must uave employees,ees,they mustlprovide theirtwo kers'comp.policy�number and state whether ar not those entities have employees. If the sub-contractors h p Y �( i I amara employer that is providing workers''cbnapensatiora nsurrrrace for xray employees, Below is the policy orad Job site information. �� _ — -- � Insurance Company Name: � ---=`—`� � � Expiration Date:_{.a+:L `_..------- � Policy#or Self-ins.Lic.#: / ----------�—" 1 � ration page shown the policy ac � r city/State/Zi Job Site Address: Eke y nd,expiration date). Attach a copy of the workers' compensation policy declaration pal, (showing p ies Parlors to secure coverage as required under Section 25A of MGL c.,152 c sin ttheto olie imposition WORK ORDERtand of fine fine up to'$1,500.00 and/or one-year imprisonment, as well as civil of nalthistatement may be forwarded to the Office of of up to$250.00 a clay against the violator. Be advised that a copy Investigations of the DIA for insur ce coverage verrfrca�{antluit tlae information provided above is true read correct. I da hereby certify urader� ns orad penalties of per? ry w Date: Sinature: R Phone#: official use only. Do not write in this area, to be completed by city or town official Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.other Phone#: Contact Person: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099497 Construction Supervisor Specialty MICHAEL L CORTNER 16 JONAS ROAD WESTFORD MA 01886`' r-'j.M 4_/ Expiration: Commissioner 04/24/2018 „« —✓4r 7`"r dsr✓ger�!/io-.v//�✓A" !<ll..rlr'fdlP;rf`✓; -= Office of Consumer Affairs&Business Regulation � -HOME IMPROVEMENT CONTRACTOR Registration: 185252 Type: � Expiration: 5/16/2018 Corporation EXPRESS ROOFING INC. MICHAEL CJRNTER 16 JONAS RD, WESTi=ORD, MA 01886 Undersecretary