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HomeMy WebLinkAboutBuilding Permit # 11/21/2016 �X BUILDING PERMIT of `�� '" -� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ Permit No#: Date ReceivedrED " Date Issued: EMTORT.A.NT:Applicant roust complete all items on this page LATI,ON -- .. Pint PROPERTY OWNER Print100 Year Structure yes o MAF _ _ PARCEL: ZONING DfSTR1CT H€storrc ® stract yes no Machrne 5hop1/illage .._._Y _ rho TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building aOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 5�ptrc iD livell 0 FI: dplaj i Wetlands N Wafe�sfiad"Distri A .1NatrlSwer: _... DESCRIPTION OF WORK TO BE PERFORMED: Yden ' cation- lease Type r Print Clearly" OWNER: Name: � Phone: - Address: Contractor Name: - - holies. . Address: �.._. : .�'. . Supewisors Construction License::C .;- E)(0. Date: ZOF Horny Imlarovemerfi License: � _ . Exp. Dat ;. . _ ARCHITECTIENGINEER Phone: Address: Reg. loo. PEE SCHEDULE.BULDING PERMIT, $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F: r . Total Project C©St: $ � FEE: $ ----- Check No.: Receipt No..- NOTE: o„NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund 5r riafure:of.A _entlOwner Sl ntr nature of coactor'= own of ndover No. h ver, Mass, ®f 10 COCAb MIC HI WI[Il �' 7.ds R^TED U BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT .....t C.9:�t.... . ........... .... .®......................... .. BUILDING INSPECTOR has permission to erect .......................... buil Ings on ..,. .....� .d ........47.!..................... Foundation dra- j� Rough to be occupied as ......... ..�...., .. ... ......1[.`.� ...,.. . !............................................................ 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI RT Rough Service e. ...... ..,. �. . . ...... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required„t® Occupy Ruildin 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. PREMIER FI PAINTING By Jonathan Na Lee 215 South Broadway,#145,Salem,NH 03079 N_:-WX ` Cellis 603-235-5731 !11 Office-. 603-890-9019 Www,premierroofingnh.cotm Submitted to: Michael Watson Date: 10-12-16 42 Lacy Street Home: N Andover, MA 01845 Cell: 508-384-6204 E-mail: Michael.lowell.watson@gmail.com Job Location: We hereby submit specifications and estimate for the following Roof repair: 6 Strip roof of 1 layer of shingles. 0 Re-nail all loose sheathing. o Replace plywood as needed for an additional cost of$40.00 per sheet installed, ® Apply GRACE Ice and Water Shield 6 feet up from edges of roof. Apply paper to remaining roof surface up to ridge. Type: IKO Cool Gray a Install 8"aluminum Drip Edge, Color: White Cut open ridge in preparation for ventilation system. i O Replace 1 pipe boot. Size: 3" ® Reroof with IKO Cambridge Lifetime shingles. ® Install Lomanco ridge ventilation. Re-lead Chimney. Clean up and removal of waste and debris. • Magnetic sweep of property. ® Walkways and drive ways swept of debris, Dumpster provided and included In job price. Notes: We Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of: Eight Thousand Seven Hundred Fifty($8,750.40) Payment is to be made in full upon completion of job. (Make check payable to Premier Roofing& Painting.) All material is guaranteed to be as specified. AN work to be completed in a workmanlike manner Authorized according to standard practices. Ali agreements contingent Signature upon accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance.This company is covered by General Liability and Worker's ConipensaWn insurance, Certificate of insurances will be sent directly from Insurance agent to ensure validity. (Nater This proposal may be withdrawn if not accepted within 90 days) Acceptance of Proposal -The above price, Specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Pay, ent will be made as outlined above, Signature r Date of Acceptance ' � I r✓o I V o Please sign and return one copy. 9 9 i The commonwealth of.Massachusetts _ DepartmeRt of. ndugtrialA.ceidents rG`ongress Sheet,stiite 100 a - d _goston,AAA-02114 ZOZ7 y,ww mass.gov/dia Wavkers' Comperrsatio)absuranceA Affidavit, dexslContlractoxslEleetricia�ns/'X nabers. TO BE FILED WTM`M PERM 1'NG AUTjXOzttiyS Please xint e '1€rI A licant�oxmation. Name(Businessl0rgabizaizonlJndividual): Phone city/state/zip Are yon au eanplayer? hecl[ttie appropriate box: Type of�project(rlerluired); aeraployer with employees(full andlor7.part tsme).* Q Ne constriictlon andhaveno employees Working tnrme in 8. Rernodeliiig -,y a sole proprietor or partnership 9. ❑D ezmlition. y capacity.pTayyorkers'enmp,insurance required.? .- [Nb workers' comp,insurancerequired.1 i 10❑B��g addition 3,L]I am.a hoineowner doing at workmyselt(1T ¢❑I am ahomeowner aadwill be hiring contractors to conduct all work onmy proper4Y- -will 1I.❑Electrical�epai?rs or additians ensure that all nontractbrs either have workers'compensation insurance or are solo 12. -bjn re airs or additions Proprietors-with n?erapl&yeas. ed nu the attached sheet. 13. ggo£zepaus 5 I am a general contr?ctor and I have hired the sub-contractozs list These sub-contractors have employees and have warkers'comp.insurance, 14.M Other 6,❑We are a corporatioft and zts,officazs have exercisedtheir right o£'axeraption per MGL c. 152,§1t4),and ive have no entpldydes.No vaarkers'eamp.irvsarance zequueri] orkers, policy Any applicant that eheoksUW-,#1 D t Edi fey�otth0se doingOTwork andtheahire outside contractors must suh3ru`ztmane'N affidavit indicating such i Homeowners who sub -t, atfi IContractars that check this liox rirusti aettacched an add y shwt showing inus pro aide theme woxkes'c omp.policy nurnber.�d state whether of}3ott�ose entities-haVo employees. If the sub-co n#ractots hzr p Y f am an employer that is prnvidir2g workers'corlzpens�atiorz insurance for my eFnployees. Below is the paTxcy arzd�o site information. l usurance Comparxy Name: / / - • N� �S!/ f / �. � -•- Eniratlob.Date .J Policy0 or Self-ins.Lie.#: Citylstatel lob Site Address: a e showi ng the policy xru3mbex an l exp�'atit n date). Attach a copy o£thexvo�rkexs3 compensation Policy declax o p g Pailur e to secure coverage as required under MGI.e.152,§25A is a criminal violation punishable by a fire up to$1,500.00 d/ox one ear hnprisonmevt,as veep as crvil penalties in the,form of a c Of"i a£7nvSTop WORK OEtiga ons of the DTA:Pox insutanca a an y day against the violator,A,copy oftlns statema'at maybe forward to coverage-vexffication. that the information provided above is true and carred J-doIzereby certrfy under thepains andpenaldes of perjury B Date: SiRnatma, Official use only. Zoo rzot-wr ite In tlxis area,to he completed by airy ar town official. • PerxnitlS�icense# City or To sfs�gAuthoxity(circle one , ' 1.)Board of Health 2.Building peparianent 3.CitylTown Clerk 4.L+lectxical Xrrspectax 5.PlrxnxlOing Xnspectar 6.Other Phone : Contact Person: -rom:Nicole Boudreau FaxID:Santo Insruance Page 2 of 2 Date:11/21/2016 09:39 AM Page:2 of 2 PREMI-3 OP IO: NB DATE(MMIDDIYYYY) CERTIFICATE 4F LIABILITY INSURANCE �,,...- 1112112016 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 pol[cy(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 lieu of such endorsement(s), CONTACT PRODUCER NAME: James A Santo P[anrightInsurance-Salem PHONE 224 Main Street Suite 2A 1Arc,No.1~xn:603-890-6439 Arc No: 803"890-6521 Salem, NH 03079 AP REss :j am le santoinsurance.com James A Santa €NSURER(S)AFFORDING COVERAGE NAIC f! INSURERA:Northfield Insurance Company INSURED Premier Roofing &Painting INSURER B:Travelers Indemnity Company 25658 Jonathan N Lee dba 334 North Broadway,Apt#307 INSURER c Salem, NH 03079 INSURER D: INSURER E 11 INSURER F 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR TYPE OF INSURANCE PO C POLICY EX LIMITS LTR € WVO POLICY NUMBER MMlOblYYYY MMlDDfYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMSMADE P(IOCCUR NN651127 05/24/2016 0512412017 PREMISES Eaoccurrence $ 100,000 MED FXP(Any one person} $ 55,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑JECT L-1 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea act#dant ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Par accident) $ AUTOS AUTOS H#RED AUTOS NON-OWNEDWPROPERTY DAMAGE $ Per accident UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ OT $ WORKERS COMPENSATION X STATUTE ER H AND EMPLOYERS`LIABILITY B ANY PROPRIETORIPARTNERE-XECU11VE Y Y NIA 6JUB-465OP25-5-13 135/25/2016 05/25/2017 E.L.EACH ACCIDENT $OFFICEFUMIN 1005000 (Mandatory In H)EXCLUDED? ❑ 3A NH E.L.DISEASE-EA EMPLOYEE $ "100,000 (Mandatory In NH} If yes.describe under5500 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required] Jonathan Lee has elected to be excluded from workers compensation coverage 0 CERTIFICATE HOLDER CANCELLATION TOWNNOA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE NO ANDOVER, MA 01845 � O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD �SZ 2 < ;x aCk uSett"5 epa rr r f o. f.Pii li Sam ��� orrt.»aarc[actclf�i o UP a kird S9��L311i�11F d����tA�iS�1Cid Off ce of Consumer Affairs$4 Busxntss Reg is "4, i s CS.T1856$7.' HOME IMPROVEMENT CONTFtACTOO` Ce7iraa> ian.Su`Pe rvtsca Registration 183321 Type-, y Expiration 913012.017 lridividual, SGOTT K NAPIER 4' 28'6ktkAND ST SCOTT K.NAPIER ; NORT14ANOOVEF2 ' SCOTT NAPIER 28 ASHLAND ST NORTH ANDOVER,MA 0l$45 _ Uiidersecl4tary Expiration, . Commissioner 081081201T