HomeMy WebLinkAboutBuilding Permit # 11/29/2016 ORT BUILDING PERMIT _I _ P, TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 7 -5 C4 Date Received Permit No#: ED CHU Date Issued: 1WOWrANT:Ap licantmast complete all items on this'page PROPERTY E rio no P nn MAP G- 01STme"T Machine Shod Vill8g Y no TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential Ll New Building Ldne family 0 Addition D Two or more family Ckl6dustrial iteration No. of units: [I Commercial Ll Repair, replacement F.1 Assessory Bldg LI Others: [I Demolition L-1 Other - rshe'd bm,�thr_r t " Pli'ofaiii Wetl' an d s, D Septi e El We[] 11 0dp Effiv DESCRIPTION OF WORK To BE PERFORMED: Identification- Please Type or Print Clearly' V­k Nam 7�Phone: OWNER e: Address: A4,OIL' Z1411 cla 0,ontr8etor Name� Ahokt '�av F Phone, L Address,: Supervisor's Glj­Ohlstruetibn Lidehse:___C5 Exp. Date.: ( 0 "2- ARCHITECT/ENGINEER Phone: Address: Rea. No, FEE SCHEDULE:12ULDING PERMIT:$12,00 PER$1000-00 OF THE TOTAL ESTIMATED COSrE3.F-kS N$125.00 PER S.F. rotai ProjeGt Cost: $_ �_L FEE: $ 41 Check No.: Receipt No,: 3 NOTE: Persons contracting with unregistered contractors do not haveaccess to the u 00 nature of A0' en-b her sidnater o b contractor, ................I.......... ................ 'Town of .1?19 ndover 0 No. ver, Mass, It's Or 0 dpo I 4P !jj15 ,v4P,4) 17 0 LAKIF COC-41c.twxI ATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT AW......jLf .... !.1111 11 11 . L BUILDING INSPECTOR .. ..... . . ... .. has permission to erect ....................... buildings on .... . ... .... . ......4.0 ....Aomak......Lm... Foundation Rough to be occupied as ...ST Chimney -�a application provided that the person accepting e�is �erm I] in every respect ...to ...terms...of ............*­ 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 AINONTHS ELECTRICAL INSPECTOR U UNLESS CONSTRU N JSA Rough Service . . ..... . ..... .................................. Final BUILDING INSPECTOR GAS INSPECTOR OccupyBc y Permit Rfluired to Occupy 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. )Q x A M * X _T_ 4M li4 SKY PHOENIX CONSTRUCTION MANAGEMENT INC. General Contractors & Construction Managers Tel: 617. 596. 1146 101 Holmes St. Alt: 617.818. 7175 Quincy, MA 02171 Email: skyphooni.xgroupgyahoo. com NAME/COMPANY: DATE: STREET 7 PHONE: Y­(q u CITY: STATE: MASS. ZIP CODE: We hereby propose to furnish materials and labor for the completion of: Old Rubber Roof Install%"Rubber Roofing Insulation Install Rubber Roofing Strip Existing Old Roof Shingles Re-nail all loose rool'boards. Replace rotted and warped wood at$4.00 per foot or$50.00 per plywood sheet. Install 3 It—or 611/ice&water shield.—Install black Paper 114i.ltall Aluminum Drip Edge.""' Install Cobra Ridge Vent. Install New Chinmey Lead(if necessary) Mall New Roof Shingle. Product,.Color: 1 b Remove and dispose all of the shingles as well as all rooting materials in the dumpster provided. Grand–Total: $$ IMe propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: –ACCEPTANCE OF PROPOSAL– I have read this document and all attached documents and accept the prices,specifications and conditions stated. I understand by signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. If an attorney's service is utilized in the collection of any amount due,the signer shall be responsible to pay attorney's fee in addition to sum due. You,the Buyer,may cancel this agreement at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. Prepared By: Accepted By: Sky Phoe o r oagement 1411 -a-e'i leu g,'kg�Wri and e` ed Owner & Personally 4 not Individua y 4 . T he Commonwealth of.M"as8a0hus"etis Deparftnent of IndustrialAecideftis . n I C'ong'es's'Street, SO100 .1 41 _ i _ ovton,.V.02114 2017 www.mass gowldxa • . y�'c��lrers' CapapensaiiaT�.Xns��x'axe.reA.:�i �� e'�,.LN'+�.�.`E7'I'.EEO7C�;.'�'.;�ricians/�'1��xnbexs. TO 331",1�':1���%l7 WIT-U ?lease�'Tiut JL e 1 A. ' licaxit Txzforxuatia�. `- Nanao(Business/(5zganizationitndivid-al): — ---- -7r Typearprajeet(T quirec ,�.xnyntt• -�znPlnyexR Checlr.tlie approprlafebnx: 7 �N�vv`cT�ast�'ct�ort l. I am a employer wia,. —employees(full andloz parC idroe).* 2.�jI am,a sole proprietororpaztnershiP and haveno employees Vrorking for in �. eutoci tion airy capacity:Uffovvorkers'romp.iusuranco required,] 9, T7einoliti*' 3.�1 am ahomc.awnez d"ging all work myself.LNOworl ors'comp.insurancerequired.]a 10 Building ZClc�xtio ¢, I am a homeowner and will be hiring contractors to canduet all work:omay property. I will 1l. Electrical TPPP4s pr a.ddiEigAs r cnsure-that all contractbrs eitherhaveworkers'compensation insurauce or are sole E _ � repays oar additions E tp ecs. . . proprietors with no em�eY 5,0 1 ani.a general contractor acct I Xxave hiredthesub-contracfars listed ontho attached sheet. 1.3.��E.b6fre&ixs Those sulx-coutraetaz's have euxploycas sudhaYo workers'comp.insurance r Hyl eT _ 5, "fie axe a oarparItioii.and its,of�scans have ercisedtlaeiz right of exempfionPor MGT,c. 152,§1(4),andvre have no employees-j: 'o workers'comp.insurance regizized.j owshowingth-irwc"k"a'C 'Any applicant that chinks bbl i#1 must al a�fit[a they arP dniug�dl work and then hxro outside emntac ozs must submit a ew affidavit indicating such I fomoowners'who submit-tlxis afdrlava Teoniractorsthatcheckihisbo jaustatta (I an additional e O yees rheyrnustpr vides their workers rkers'comp�Poliaymxmberandstatewlxathsrorixatthasoetttit7es ave employees. If the sub-can �— ~ a� .xz emZ�ioyeC f�iczt is pr^oar"cling-workefs'colnpensatiorz insu)Wncef0l'my Mpj6yees. ,lielo19 is tlz pair. an ram djo�a site iazfozTna r"on. Insurance Coraliany:N.e: -f_04-----------_-- _ — — ExpirationDpte Policy f or SON itis.Lic. _ City/State/Zip:______-_. idate). TobSiteAddress: ra i Ataelz a copy of-lheWQrkexs' coxpensationpolicy declaration hhn inal-violation Failure to sectrta coverage as required�tnderNl enalties xrxtl�e xnlo��"i'OP WOT,�T�.pORDER and a fan of p to $;150.00 a and/or one-year hap., a swell as civil.p pof the W.for itasaxanoe, day'against the,violator.A copy of tat"Mon:t xxnay lie forwarded to-the OfC Of ans coverage Vexicatinu. do 7zere�y csxtify d t e 'Perjure t7zat th ortnadon pro�rWed abo:1 ,is h-e VJ co�recz 'a jC� ,si a_tare Official use only, Un clot-wr'ite in,tIlkV area,to 7xe carr Meted by city 01'tarvri'official Perm it/Lice=50 Ci:ly or:YVM— fssui71g'A-Mthorlty(circle one): :f..Board of ffealth �.Ixxil�lixagDepart�nept 3.City/7'awn Clerlr 4.Elecfricalxnspectox 5. irtnibir�l;xnspectar 6.Other aco o® CERTIFICATE OF LIABILITY INSURANCE 71T 1/2812D,YYYY, f, 1128I2a16 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(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 endorsement(s). PRODUCER 00$82_001 �RMNTEJI.CT Branch 882-1 j WIC Insurance Inc ALCNv.Ext: (781)890 0999 (AjX.No.: (781)890-7216 230 Second Avenue Suite 105 EMAIL Waltham,MA 02451 ADDRESS: INSURERMI AffORDING COVERAGE __ NAIC ff '.. IN 3375 IZ A, A.I.M.Mutual Insurance Company _ $ INSURED INSURER B: Sky Phoenix Construction Management Inc – INSURER 101 Holmes Street INSURER D:_,_,�. Quincy, MA 02171 INSURER E; 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 BYPAIDCLAIMS. IPTR TYPE OF INSURANCE u INSR Sj UEp POLICY NUMBER POLICY LICY EYYY C EXP POLICY OLILIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PPREMISES ( RENToccED $ EM1Ea urrence CLAIMS-MADE F—]OCCUR MED EXP(Any one person) $ – PERSONAL&ADV INJURY s GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ OLICY Ea OC AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE T$ AUTOS Per accident _ $ UMBRELLA!IAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE g DED I RETENTION $ $ O•-_ A�� V4C SL1MIT OTH- yyDRK Rg C S X TORY LIMITS �R AfJD E�PLO S IA I AI�yPR�p p�7/pp(�rNEw EXECUTIVE YIN E.L.EACH ACCIDENT $ 1 000 0 ,QO A DFFICERIER EXGLUDED7 � N f A vwal00-6018994-2016A 711212016 711 212017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If Yes escfitre under E.L.DISEASE.-POLICY UMiT $ DLSCIIPTION OF OPERATIONS below _ _._ _ 1,000,000,0-0- DESCRIPTION 000 0DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover 120 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE d 1888-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD SKYPH-1 OP ID:GP DATE(MMIDD"W) CERTIFICATE OF LIABILITY INSURANCE 11/23/2016 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(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 endorsement(s). PRODUCER CONTACT Gail Prescott WIC Insurance Inc. NAME: 230 Second Avenue Suite 105 arc°No E:d1.781-890-0999 1 FAAre Nei:781-890-,.7216 Waltham,MA 02451-1102 >•MAIL Gail Prescott ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Ataln. eciaity_Insurarice Co INSURED Sky Phoenix Construction INSURER B:Massachusetts Workers Camp Management Inc. 101 Holmes Street INSURER C: Quincy, MA 02171 INSURER D: INSURER E: INSURER IF: 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. _ [NSR TYPE OF INSURANCE DDL BR POLICY NUMBER PO EFF MN DIYYYY LIMITS ICY_E9fF_ ETR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CIP209928002 10/0112016 1010112017 pREMIS:S Ea po ante $ 100,00 CLAIMS-MADE [X]OCCUR MED EXP(Any One person) $ 6,00 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE_ $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPrOP AGG $ _ Exclude POLICY PRO- $ _,wW JECT AUTOMOBILE LIABILkTY COMBINED SINGLE LIMIT Ea a.d.n' $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ MIRED AUT05 NON OWNED ROPER ENT)DAMAGE $ AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAS _ CLAIMS-MADEAGGREGATE $ DED I I RETENTION$ _ $ WORKERS COMPENSATION WC STATU- DTH- AND EMPLOYERS'LIABILITYTORY LIMITS I _ ER B ANY PROPRIETORIPARTNERIEXECUTIVE Y r N CERT TO FOLLOW E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN-67 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of N.Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street N.Andover,Ma 01845 AUTHORIZED REPRESENTATIVE C� . ©1986-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-093609 Construction Superviior- MICHAEL Q LEUNe r 101 HOLMES STREE. ; QUINCY MA 02171 Expiration: Commissioner 10/16/2017 � (_Tx' er VIMr.R(Of llll VC?AlrUac�r�uv�fs office of Consumer Affairs&Business Regulation ' HOME IMPROVEMENT CONTRACTOR _} Type,. Corporation �T Reamstrafion Ex it tia /� 179979 09/24/2018 SKY PHOENIX CONSTRU TION MEMENT INC MICHAEL LEONG 101 HOLMES ST,".. � QUINCY,MA 02171 Undersecretary