HomeMy WebLinkAboutBuilding Permit # 12/28/2016 ` ORT BUILDING PERMIT TOWN OF NORTH ANDOVER w , APPLICATION FOR PLAN EXAMINATION _ A Permit No#: Date Received ! CHUG Date Issued: IMPORTANT.Applicant Faust complete all items on this'page } ' CATION - � nnt PROPERTY OWNER - Pnnt [ o Year Structsire yes Cao PARCEL ZONING: DISTRICT Hrstortc ®istnct yes o .. � - Maciltne Shop Vt�lage, yes _. .pn . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic .D ry1/i1ef1 " D. odplain 1lilet[ands` > Wat- -lbrshee[ �istric ., DESCRIPTION OF WORK TO BE PERFORMED: le Identification- Please Type or Print Clearly' A OWNER: Name: Lem C Phone: &o3 Address: tC rl e I gq COftti`gd-tOr Name:- _ e: - Address:, l04 43 ` 5upervisars Can"s t ct► ll License __C: ._ I -: Exp: Dal c-, Home liri ravement Lti✓ense ��_ .� _ :_.. Ex Date ..... ' �'� �-� _-. �...__ ARCHITECTIENGINEER Phone: Address. Peg, Ido, FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. .Total Projeot Cost: $ :� FEE: $ V Check No.: � S �/` 3 � Receipt No,=_. NOTE- Per=sons co tracting with unregistered contractors do not have:access to the guaranty fund -- _ - �ln_A i it . ' -'Arrant ._ rrsfnpr tCirr re 6 CO roc or'? ............. ............... �®RY�y 'Town o n over . 0 Y� No. 0 h ver, Mass, 1 2 KATIE 1) co BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .........AIN .......RAII.O.....9.... .....3,gf. V"a BUILDING INSPECTOR ..................... has permission to erect ................ ......... buildings on ....df u..... gw.y.....COA.......... Foundation Rough to be occupied as ...UST.4. .......*....... ......................... 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 PERMITEXPIRESIN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTTART DTQA Rough I Service .......................... Final BUILDING INSPECTOR GAS INSPECTOR OcfMancy Permit Required to 0 LLq_eE 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. Owens Corning Platinum Protection Certification Number-217736 Sentry Roofing K/A LMPH HOLDINGS 40 King St.Suite 2 Auburn,NH.03032 PROPOSAL Steven Seero December 22, 2016 46 Copley Circle North Andover, MA. 01845 Re: We propose to replace all roof areas at the above address except areas Job/Site Preparation - All work is to be performed within accepted OSHA guidelines - Work area is to be kept clean at all times - Care is to be taken to protect all landscaping and personal property Removal - Tarp house and grounds prior to stripping the existing roof, house is to be protected from leaks at all times. - Remove all the existing roofing material to wood sheathing, re nail any loose sheathing - Replacement of any sheathing if needed will be done at a cost of$ 42.00 per sheet - Remove and dispose of any and all job related debris per state and federal requirements - Magnetic sweep all affected areas - The two existing skylights Roofing Installation Page I of 3 yWe Commonwealth of Massachusetts _ F Departme9t ofIndustrialAcciderats I Congress Sheet,State 100 Boston, NIA OZZZ42017 �q w ww mass.gov/dia a�M - (Vke)rb, Compensation jwurance A Ada-dt,l3auders/Contaetors/EYeetxiciansll'Z�a�ers. 'xQ BE FILED Wll'J'H�PERIYJ-f:I.'��NG A.TJ')?SQR�T•ty. Pleasekriut Le '!ai A ant information Nas>le pusinesslOxgaziiz Address: 4Q t Nom! !3 03, Phoria#: (G� ' -7-7N ecktiie appropriate box: Type of project(xegnixed); Axop anemplayer.Cb , em leyees(#'rill and/or pari-time).; 7. d New coxLsfirucialo7� 1. Iamaemployeruith_.. .— p 2.❑Iamasolprop,jotororpartnershipandhavenemployees working formeirz 8. Remodolii3g e any capacity.[Noworkers'comp.insurance requi€ed.I 9. ❑DoMoliti0a 30I am a homeowner doing all workmy,0f,jNo workers'comp.insurance r�qu red.]t 10 0 Building addition 4.❑Iamahomeawnerand'will.behidngcontractorstoconduct:all.workonmyprapertY. "wVM i.❑Eieotzlcairepairsoradditions ensure that all cantractozs either have vvorkcrs'compensation insurance or are sole 12.K plMaDing repa#,s or addidow proprietors with no e p�8yees. I I 5.❑I am a general cnn#zactor and Zi?aYe hised.the sub-corrt€actors listed on the attached sheet. 13-.KRbafre&irs Iiaesesub-contraciro"s aye employees aadhave workers'camp.insurancet 4M Other �,❑We are a corpnrafaoliand its,officers have exere9sed-theirright of exemption per MGL G. andvehaveno enpinyees.�i3oworkers'comp.iusurancerequired] ,�xryapplicautthatchecks bi��#7mostalsoillontthesectionbelowshowingtlaeirworkers'compensationptoTs allustMbmit atEon' I Ilomeovvners who subu it thfs affida vit indict au additional they mt�shetshovi g thnnamr of the sub,contractors and state whc ther or no�tthoseenfities Kaye l� tcontractors that check this boi,zn employees. Iftho sub-contractors have employees,they must provide theh vrarkers'camp.policy number. ,-am are ernployer that ispr ovidingworkeps,compensadoB irzsUrance for°my exrzployees Below is the pofacy arzd j Oh site information. Insurance Company 1q e. p �g ExpixationDatel 5?� ly /?okay#or selfius.LXo.#:. `C J � �YG� City/state/Zip: rL � ?`�`�I �1J/4 lob Site Address: ShaWhag the policy numb or and eXpu a 1,50 date). Attach a copy a£ihe oxkexs' co. pensationp0Hey dedarationpage( Failure to secure coverage as required-rider MGL e_ 152,§25A is a criminal violatiort punishable by a foie up to$3.,500.00 and/or nne~yeax ivaprisonm crit,as-Well as civil penalties xnthe f oz vaxded to th OfS ce o ORDS ion of the DIA fox i�suxanc0 a day against the violator.A copy of tTsis statement may b f coverage-verdflcation. �do-hereby certify under tlzsperiras arxcTpenaTties ofper jury that tTie information provided above is true and Correa" . Date: Si ature• G Phone#: official use orxly. .ID0 not-ivrite in this area,to be completed by city or town offficiar Permit/Litcense# City or'I'o-vm'° IssuitxagAutlxoit5 (cixcXe one). ' I.Board of�caTth 2•l'dxxild:ixrg Department3.CztyfTvvvn Cl.exk d•.EIectxicaXliispector S.Plumbing xuspectar 6.Oilier Phone#: Contract person: KKAPTON READE & WOODS Fax 6034644066 Dec 28 2018 09:20am P001/001 LMPHHOL-02 BMERRITT CERTIFICATE OF LIABILITY INSURANCE DATE(INNli]DlVVYf) `.---- 1212812016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES € EF-LOW. THIS CF.RTIFICATE OF INBURANCC DOES NOT CON;TITUTtT. A CONTRACT SETWt:EN THE ISSUING IN URER($).AU I HUHILI=U REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 notoonfer rights to the Certificate bolder in lieu of such endorsement(s). PRODUCER ICME:_."TACT N Knspton Koade 8 Woods Agoncy,Inc. PHONE - - FAX - 22 School Street €Arc,No,e n:(603 464.3422 !arc,N�. 603)x464+4066 Hillsboro,NH 03244 EMAILL INSURER,(S�AFFORDING COV[RAGE NAIL 8 INSURer{A:Na€•p,tilus Insurance Co _.. ..._. 17370 INSUREDIrIsURER e:Proalressive Insurance Group 24242 LMPH Holdings LLC dba Sentry Roofing -INSURER C:Berkle Risk Administrators _ 40 Kln St g INSURER D: I Auburn,NH 03032 - ':Nsuw 1 ENSURER F COVE ES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I$$VED TO THE INSURED NAMED,gEOVE FOR THE POLICY PERIOD MDICATED, NOTWITHSTANDING ANY REQVIREMENT, TERM OR GOND€TION OF ANY CONTRACT OR OTHER DOCUMENT"WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSLIRANCE� AFFORDED BY THE POLIC155 DESCRIBED HEREIN IS SV15JECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF'SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. _ •_�_,.� AODL SU9R •• T_ •— -PO(-I("V EFF POLICY EXP _ R TYPEOr INSURANCE I POUQY NUIUPER MltlD1YV'YY IAM - WAITS A X 'COMMERCIAL GENERAL LIANILITY EACH q! CURRENCE _ 1,000,000 CLAWS-MADE [y( �OCCUR NN736288 11/04/2016 11/0412017 DAMAGE TO RENTED 100,001) PF�A15 ES IPa.eesaFrcenri,9}^�__. _ I'!Eo ExP An pne ef9on g 5,ODI1 PERSONA!&ADV INJURY 5 -- 1,000,000 N'LAGGREGATE LIMIT APPLIES PER: ., l GENfRALaG ,REGATE S 2,000,000 pRo,, I—! POLICY_J JECY v tqC PRODUCTS-COtAP/O.P AGO 5 TH R' S AUTOMOBILE LIA�ILIN COMAINEO SINGLE LIMIT 5�0 d00 .OG=iomlt _ S ANY AUTO I 025644011 071139/,201111 0710912017 5OCILY INJURY(Par crson S O'ANEDH DULED • AU��TEEO��S ONLY x A•VTIJS EODILY IN RY(Per e64ld8nl AU7d5ONLY SOT-pWN p PROPERTY AMAGE V 05 r)N�Y PROPERTY UMBRELLA LIAG OCCUR _EACH OOCURREN�., 5 EXCESS LIAR_ OLAnd$MADE A R ATE_.__.. S.__.. OED RETENTION S I $ C wORKE R$COMPENSATION !P7ATUTE_, ,-, . 8� AND EMPLOYERS'LIARILITY —•-• WC28B300658601 05!28!2018 0512&!2017 100,000 ANY PROPP,115 lPA.RTNERrEXECUTIV6 r�, E S;�AGti ACC10ENT _ S r=Pjm9.1:6aiory In HH)aER ExGLUOED? J:N l a j E.L.DISf.J .GAC 9 100,000 l do clary In HH) 500,DU0 If yes,desrn5 undw SGRIvrION 4F OPERATI ,, b0ow E.L.DI POLICY LIMIT S ( f DESCRIPTION OF 0PERATI0r33 f LOCATIONS i VEHICLES IACORD'I e'I.Addllional Remar%s 9chedu€e,m@y be attachad P more space Is rop.,#red) u 'Workers Comp Info: Excluded Officer(NH): Paul Modzeleeki 9 Ra:Steven Seero,46 Copley Clrele,North Andover,MA 01845 R CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St North Andover,MA 01846 AUTHpRIZEQ REPRESENTATIVE is i. ACORD 25(2016103) ©1988-2015 ACORD CORPORATIONS, All rights reserved. The ACORA name and logo are registered marks of ACORD { e Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-109956 Construction Supervisor > PAUL MODZELESKI 3 280 STARK HIGHWAY SOUTH DUNBARTON NH 03046. (�Z7 l_ Expiration: Commissioner 05123/2020 Office of C'nusurner Affairs&Business Regulation (1 'r2 HOME IMPROVINENT CONTRACTOR �l "' l Registration.— 47. 8126 Type: ,5 Expiration., 811201& LLC LMPH HOLDING LLC DBA SENTRY ROOFING PAUL MODZELESKI 40 KING ST. AUBURN,NFIr.03032 Undersecretary u 3 I j