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HomeMy WebLinkAboutBuilding Permit # 12/5/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR.PLAN EXAMINATION " Permit No#: Date Received S"'CHUS Date Issued: IMPOKfANT:Applicant must complete all items on tbis'page LE)6AT`I@N ,, pliht 100 Year Structure Y6!§ no MAP, (P PARCEL: ZONING D I STR I @XT- Historib Distriet yes no Machine Shop,Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building El One family 0 Addition aall�o or more farnily I-] Industrial fteration No. of units- 0 Commercial air, replacement 0 Assessory Bldg 0 Others: [I Demolition Li Other Septic ' - b Se'piq 0 W611 0 1716od-pipin 0 Wetl' nd8 E� a ers ed, District ric, Water/Sewer L']YVatqr/$ er DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly xArz Phone: �LA. OWNER: Name: Address: C Cr oritra6tor, Narne,_ �*(Pho 0 nt Address: u uc Supervisor's Gonstruction License: 1 Exp.p. [Date: . Horne 7) Home Imp e t License. 7Z Exp. Date, -- ------ -__ ARCHITECTIE N G I NEER Phone: Address: Reg. No. FEE SCHEDULE.-BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125,00 fga .F. r, --,Tbtal ProjeGt Cost: FEE: $ Check No.:---/ 4'Peceipt No,- '3 1 '62 a t'rac , nr ave'--access to t1legilarant f nd NOTE: Persons contracting witli unregistered d c ni "n ---------- Si nature of contractor t" f 9 AlY., 'T NORTly own o TAndover No. * -� _ C)6 s h : .� ver, Mass o cocaucnjwicK 1' � u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT VATrA... BUILDING INSPECTOR ...... .... ........... Foundation has permission to erect ............... buildings on ........ .�.'.. . .... , .Q .. � Rough to be occupied as p ....Sm..to.....f....... .....� . ................�.�.��.�.,..�.��.�.�.... 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 CONSTRUCTION-STARTS Rough ffService ............ ... .................................... 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. Contract Vinny's Construction Phone 617-669-7952 TERM : CASH DATE: NOVEMBER 21, 2016 To: Giao M Tran 10 shaker hili lane CONTRACTOR: VINH TRAC Woburn Ma 01801 CONSTRUCTION SUPERVISOR LICENSE # : 094891 HOME IMPROVEMENT LICENSE # : 156593 INSURED BY: PENN AMERICA INSURANCE COMPANY 3obsite address : 20-22 Robinson ct, North Andover, Ma : strip and re-Roof, install vinyl Siding UNIT TOTAL DESCRIPTION QUANTITY PRICE Roof Complete strip all existing roof materials on roof Check for loose board , rotten board , add nails for loosing boards on roof, replace rotten boards if needed ( up to 2'x 8' boards free ) Install ice and water shield 3 feet up from roof edges , install roof paper for the rest 8300 of the roof floor( 15 lbs ) Install new drip edges (white, 8 inches) all around edges, new pipe booth and all new flashing . Install new architecture shingles {owner choice of color) , install rig vent on top for 27000 ventilation Siding Install 3/8"foam insulation all around the house , 17500 Install new 4"type vinyl siding ( owner choice of color ) , Complete cover all windows trim and fascial boards with white aluminum , install white soffit for roof soffit d Gutter Install seamless gutter around the house 1200 30 yards dumpster will be onsite for debris, all permit fees included Payment. $1000 upon the day contract is signed to apply for permit (non-refundable ) SUBTOTAL 27000 $16,000 once permit is issued $10,000 once the job is completely done DISCOUNT AMOUNT PAID OL TOTAL DUE 27000 F Owner 1Y Contractor r is j. �! DATE(MMIDDfYYYYI '. AC"RV CERTIFICATE OF LIABILITY INSURANCE `� 1113012p16 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 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: Vincent PaCi BROADWAY INSURANCE AGENCY PHONE E 617)387-8600 AIc No: E-MAIL vincent@broadwayins.com 810 BROADWAY INSURER(S)AFFORDING COVERAGE NAIC# EVERETT MA 02149 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: VINH FRAC INSURERc: VINNYS CONSTRUCTION INSURER D: _ 680 BURNCOAT ST INSURER E: WORCESTER MA 01608 INSURER F: COVERAGES CERTIFICATE NUMBER: 107313 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. ADDLSULTR TYPE OF INSURANCE INSD W D POLICYNUMBER POLICY EFF MMfbDNYYY LIMITS LFR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ .__.._._,.. RENTED CLAIMS-MADE D OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ -- NIA PERSONAL&ADV INJURY_ $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECTPRO- ',! LOC PRODUCTS-COMPIOPAGG $ W...__ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ -- ALL OWNED SCHEDULED NIABODILY INJURY(Per accident) $ AUTOS AUTOS _ NON-OWNED PROPERTYDAMAGE $ HIRFDAUTOS AUTOS AEer accident UMBRELLA LIAB OCCUR ti EACH OCCURRENCE $. EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ —� DED RETENTIONS �/ $ WORKERS COMPENSATION _ X SEATUTE I ETH AND EMPLOYERS'LIABILITY -- ---- ANYPROPRIETORIPARTNERtEXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? NIA NIA NIA VWCtpp60218132016A 11123/2016 11l2312017 --- "' "--__-- ---- -- _-- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 _ Ws,describe under - � CRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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 authorization 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. j This certificate of insurance shows the policy in force on the dale 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 dally by accessing the Proof of Coverage-Coverage Verification Search tool at www,rnass.gov/lwd/workers-compensationAnvestigations/. Sole 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 Town Of North AndoverACCORDANCE WITH THE POLICY PROVISIONS. 120 rl1aln St AUTHORIZED REPRESENTATIVE North Andover MA 01845 panieI M.Crortley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE,MMI°DlYI YY) 11-21-2016 F 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. L IMPORTANT: If the certificate hotder Is an ADDITIONAL INSUR the policy(les) must be endorsed. It SUBROGATION IS WAIVEb, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rIghtE to lh certificate holder in lieu of such endorsement(s), § PRODUCER NAME: Vincent Paci Broadway Insurance Agency PHONE (617) 387 - 8600PAX 617 389 - 0819 (AIC,No,Extl: (AIC,Ho):( } 810 Broadway E-MAILADDRESS: Everett, MA 02199, INSURERISI AFFORDING COVERAGE NAIC® INSURERA:Penn America Insurance Company INSURED INSURERB: Vinny's Construction Company INSURERC; 680 Burncoat St INSURERD: Worcester, MA 01606 INSURERS: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDIT30N 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 -T - POLICY EFFPOUCYEXP LIMITS LTR TYPEOFINSURANCE INSR WVO POLICY NUMBER IMMIDD/YYYYI IMWDDlYYYYI X GENERAL LIABILITY PAV0035224 10/27/16 10/27/17 FACHOCCURRENCE $ 1,000,004 UAMAUL x COMMERCIALGENERALLIAaILITY PREMISES(E.aocur Ae ) $ 100,000 CLAIMS-MADE I n E OCCUR MEDEXP(Anywepema) $ 5,000 PERSONAL&ADV INJURY $ 1,000,004 GENERAL AGGREGATE –72 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLlCV PRO JECT AUTOMOBILE LIABILITY (Ea awdenq $ ANY-701 BODILY INJURY(Per person) $ ALLOWNEO SCHEDULED BODILY INJURY(Per ar of no S AUTOS AUTOS NON-OWNED HIREDAUTOS AUTOS (Per acadent) UMBRELLALIAB OCCUR F.ACH000URRENCE. $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DEO RETEN71ON S $ WORKERS COMPENSATIONCSA - TH- ' AND EMPLOYERS'LIABILITY 70RYLI&11TS EA YIN I PROPRIF.TOWPARTNEMEWCUTIVE E.L. ACH ACCIDENT OFFICERYMEMBER EXCLUDED? F-1 NIA $ IMar,datogTn NHI FX,DISEASE-EA EMPLOYEE S I(yes,describe Imder V DESCRIPTION OF OPERA77pN54eIaN I EAAASEASE-POLICYLIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES#ABach ACORO SoI,Add3tlonatRemarks Schedo}e,if more apace Wrequlred) Carpentry NOC 0 CERTIFICATE HOLDER CANCELLATION Town of Noth Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover, MA ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORrzEO REPRESENTATIVE 011988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Ae Common-Wealth of Massachusetts Department of IndustrialAceldefifs F X Congress Street, Sante.700 X __✓��__ d Dnstgn,MM 02114 2077 wr WWW.Mass.govIdra -W('lker's' Compensation bsuraRceA.fda��$����GAUaT�EOs��txiciax�slPX,r�vz�aers. TO-BF,I? F,)D WffHTnE Please Print Le 'bl A ' 3icmt luf M tzoYt Name(Business/Oigaf&atiovllndividual): Address: � Pho CitylstateiZip;—Wbbte : ( t - Type of pxoect Are you an employer?(]re*the appz'opx'iatehox: , a employer witlz__..�� .-en ployees(tll andlor pai t time). '], ❑N��r co�sLrtr'oiion 8. Rexnodalitig 2,0IamasoleproprietororpartnershipandhavennemployeesWori�ingozzneiar ��elTio�iti4ll any capacity.[goyvorkers'comp,insurance required.] 9.3-El I ani a hoinaowner doing all-work myself[iIu workers'comp.insurance zequired.l 10 0 Building additio-R 4.n I am ahomcowner andwill be hiring contractors to cond€rct all wozk on my property. Iwill 1 Y.❑ lectxicalxepas or additions ensuzetbat ancnntrackots either 12 insurance or are sole PTi�m ixag rep*,3 or additions prapriatazs with na e�xtpiayees. - $.❑I am a general coatr4ctpr and lbave hired.the sab-canffactors listed on the attached sheet 13.Q Roo£repaixs 9 Thesesub-ctmtractors have employees and havoworkers'comp.insnazance.t 14.' Other �,❑Wearoacozpnrationandits.officershayeexezcisedtheisriglitofexemptionperIVIG n. 152,§1(4),aad Sys hage na emplriyees.llTo workers"romp.insurance required] V their workers'compensation policy information: u a,,paBPlioantfihat checks;box#].rausE also ttil.out the sectinnbelow showing T Hoaneawners who suiomit ttais a f�davjt indicating they ara doing all work andthen rise outside contractors must suhmzt a new not 1 os indicating such r.: Cnntractozs that checl�this box must attaclied.an additi m r q hde their Workers,comp.palinynumber. d statewhether of nntflrase ent�tles ave employees. 7fthe sub-cnntzacErrs raga employees they p o er that is providing Wor1rers'compensation instil ance for my e�nproyees. Below is t7aepaiicy acid j o7�site lam axe ernpl y iftformadon.. UVAr surance CompanyNama: L. IxirF �irar � C E tionDte' Policy#or Selins.Lie.#:. ii 0- h S -� City/State/gip: l�• 1, JoT�Site Address.' �- c a ca oche wozl�exS' coanpegsationpolicy decla_ratianpaga(STxovvi�zgtYtepolicy:an t eaa e $1,500-00 ) -UP to Atte Tz copy Failure to secure coverage as required under MGLalties��the iOrxn of ais a �SmTOI'WORD ORDEK and a fine,of up to $254.0 0 a and/or one-year impxisox�mant,as u�e11 as civil P a airust tire violator. A copy of this statexna�zt may be i'orwarded to the MOO oi:Snvestigations o�the DIA tox insuzaxtce day g covexage-verification.. X do 7i ere7i e�tify der'tree prxirzs Andpenarties of perjury t7iat the znforrrzatioi2 p:ovaderi aha ve i�trr�e and correct y Date: Si atuxe: f r Phone#: l� b Offacial use onry. Xao nat-wpye in t72is area, lobe carr2pleted y city or to i offxciuZ. • P�er:rxritll.icexrse# City'or To vvn- IssuingAuthority(circle one): ip actor I.Board of l eaXtir PnYlding Beparttnent 3.City)To-wn Clerk 4.I+lectxicaT Xxxs ector 5.Prom ing Xxtsp 6.other Contact Person: j� �C'r`Irn'trrurrxaiittxrrr�t�r.�C'�llre��rrc�rrtellJ K �'=—� Oil't�c'oFConsume�•,.�'�'taia•s&Bossiness Reg�!aEoks Ih7PROVEMV NT CONTRACTOR Ie9istratio r.: *693 Type. {� 7Expiration 71.172017. OBA ViNw"S'-('0'NSTRUC f10N -:} V pfd FH ,k��15i'' . •.. ` 630'BURUWAT ST 11 fORCE,9I EP, MA 01606 pndOseeretary p Massachusetts Department of Public Safety - Board of Building Regulations and Standards License: C5-094891 Construction Supervisor d VINH C TRAC ° a8Q SURNCOAT STREET' p WORCESTER MA 416516 t :<.. Expiration: 07/1912098 Commissioner o i;