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HomeMy WebLinkAboutBuilding Permit #242-2016 - 108 ROSEMONT DRIVE 8/26/2015 t ORTFf BUILDING PERMIT TOWN OF NORTH ANDOVER w , EAPPLICATIONC FOR PLAN EXAMINATION Permit N0: Date Received 'b I - Argo Date Issued: l'S �,ss�+caus IMPORTANT: Applicant must complete all items on this page LOCATION Q y � � P 'nt . PROPERTY OWNER ``44 k& . 5 r+L Print MAP NO: 010 PARCEL:�3 ZONING DISTRICT: Historic District yesAno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE R7ne tial Non-Residential ❑ New Building family ❑ Addition ❑ Two or more family ❑ Industrial ❑AAeration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: �C:c l ;Shy,, /I Phone: S,,M-- 397"4©S14 Address: I ,r CONTRACTOR Name: Phone: Ct LS'&4--237 Address: fo Supervisor's Construction License: 'D I 1 Exp. Date: ��r ' `( I Home Improvement License: Exp. Date: r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED/COST BASED ON$125.00 PER S.F. Total Project Cost: $ , ,. a FEE: $ `foa . / Check No.:�74 Receipt No.: .2 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor a�4 �� ` • a ' a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanuing/Massage/Body Art ❑ Swimming Pools 11 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments r Conservation Decision: Comments I Water& Sewer Connection/ Drivewa Permit DPW Town Engineer: Signature: ,FIREiDERARaTdMENtT TernpDumpster,onksite; ,yes_ Located 384 Osgood Street ► Located at 2124 MamfS"� — - v- - - FireDepartment=<signafure/d`a'te; 'COMMENTS: _ J` - - -Y Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4, Building Permit Application ;rF Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 16 Copy of Contract 4 Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit I In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location t V �U Se\r\A No. t�"'Z O,leo Date k� • - TOWN OF NORTH ANDOVER , Certificate of Occupancy $ Building/Frame Permit Fee $&DI Foundation Permit Fee $ Other Permit Fee $ i. TOTAL $ - S Check o��7 ri uilding Inspector NORTH own of E I�zai-L - , Andover 0 10 No. h , ver, Mass, O coc NICNIWICK A�"Wr E O i'*' S V BOARD OF HEALTH Food/Kitchen PER ly T LD Septic System THIS CERTIFIES THAT ... ..�,.' ..... °. .�!,!a ......... BUILDING INSPECTOR ...�. Foundation has permission to erect .......................... buildings on tak........ .. 4►l�!!Vc.. .............. Rough to be occupied as ........`.3., ....... ..... ...... .. .. ............ ..... ...... Chimney provided that the person accepti this permit shall in every respec onform to the terms o he application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspecti n, 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 MONT S ELECTRICAL INSPECTOR UNLESS CONSTRUCTWO Rough i Service ............ .......... ..................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy 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. GG o° •• NO Craig LaCrosse-Owner ESTIMATE PO Box 728,Tyngsboro MA 01879 July 22,2015 978-580.7376 craig@roofingkingirx.corn Customer: Kal Shetty Address: 108 Rosemont Drive,North Andover MA Postal Code:0184S Phone: S08-397-0056 Email: kalshetty@aol.com Thank you for allowing Roofing King Inc.the opportunity to work with you. Here is a list of the work to be completed,the agreed price and payment structure. Please feel free to contact me with any questions or concerns at the number listed above. SCOPE OF WORK: Full roof replacement(Due to acts of mother nature) -House will be covered with roofing blankets to prevent any damage and for easy cleanup -Remove all shingles right down to existing wood and re-nail and prep before installation process begins -install up to 96sq ft of rotted plywood(3 sheets 1/2 roof plywood)at no charge on any full roof replacement&$50 per additional sheet if needed -Install 6 ft of GAF Storm Guard ice and water shield leak barrier along base of roof and areas listed below -Cover all valleys,snow load areas,under all flashings,wrap all penetrations including but not limited to chimney's and sky lights -Remove and re-install new plumbing flashing on soil pipes vented through the roof -Install Rhino Roof on any exposed wood before shingles are applied -Install new 8" (color)drip edge on all edges of roof for proper protection -Install GAF Pro Start starter strips around entire perimeter of the roof to create a 1/2 inch overhang for proper install -Install GAF Architectural Timberline HD LIFETIME Ltd.Shingles will be storm nailed with 6 nails per shingle 130 MPH resistance -Cut 11/2 inch opening on peak of roof if it wasn't previously done for proper installation to meet building code(on full replacements) -Remove old lead around chimney and reinstall 12 inch lead and reseal joints(if applicable) -install Cobra exhaust vent on peak of roof to allow proper ventilation and meet building code -Hand nail Seal A.Ridge caps on peak of roof with 2 inch nails to complete installation. -Blow off entire roof,driveway and all walking surfaces and clean any loose nails with 3 ft rolling magnets daily or on completion -Existing roof will be removed and recycled at Roof Top Recycling(Certified Green Roofer) Optional Upgrades (on full roof replacements) -Weather watch upgraded to Storm Guard Ice and Water Shield $0.00 Included -Remove skylight flashing kits to install ice and water on all 4 sides(reinstall existing kits) $0.00 Included -Deck Armor in place of Rhino liner $200.00 Not Included Warranty Roof comes with 50 Year Weather Stopper System Plus LTD manufactures warranty Promotions Military,Veterans and Retirees receive a$250 Rebate through GAF when purchasing a GAF Lifetime Roofing System. PAYMENT STRUCTURE: This price includes labor,material,trash removal,building permit if required and contract may act as signature for permit. (Any additional work will require separate pricing) Make all checks payable to Roofing King Inc. Total: $14,040.00 4500 Act Fast Coupon(Exp.7131) $14,040.00 Deposit(due at signing): (113) $4,680.00 2nd Payment(due when material is onsite): $0.00 �L Final payment(due_upon job completion): (213) $9,360.00 ��-cs o SHINGLE COLOR: "�4 initial. UAI&Akket-_ c�� egg 115'0. ACCEPTANCE Of PROPOSAL The Inclug-ed specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specifivi. PayrneM w1U be made as outlined above and accept all terms Included.All discounts on all work to be done must be presented to Roofing King Inc.representative before contract Is accepted. If rotted wood is discovered AFTER removing the existing roof,or it could not be identified at the time of sale an additional charge of$SO per sheet If this account is collected through legal actions,customer will be responsible for all attorney fees and court costs. Disclosure:Customer responsible to cover any valuable Items In the attic to protect from debris.Roofing King does not assume responsibility for acts of Mother Nature. li Owner/Contracto Prope Owner Craig LaCrosse Kai Shetty S\ The Commonwealth of Massachusetts Department of Industrial Accidents A 1 Congress Street,Suite 100 - Boston,MA 02114-2017 M www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual):Roofing King Inc Address:Po Box 728 City/State/Zip:Tyngsboro MA,01879 Phone#: 978-580-7376 Are you an employer?Check the appropriate box: Type Of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 1E]I am a homeowner doing all work myself[No workers'comp.insurance required.]t ❑ Q4.DI am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.2]ROOf repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Star Policy#or Self-ins.Lic.#:WC 0742797 Expiration Date: Job Site Address: C City/State/Zip: IggS'- Attach a copy of the workers'compensation policy(declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby fce�rtify under the pains and penalties of perjury that the information provided above is true and correct; Signature: UUV4 � Date: Phone#:978-580--7376 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ,aco CERTIFICATE OF LIABILITY INSURANCEFAm,,',mwDDNY" 15 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(iss)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: McSweeney&Ricci Insurance Agency, Inc. PHONE FAX 420 Washington Street E-MAIL P.O. Box 850984 aoDREss: Braintree MA 02185 INSURERS AFFORDING COVERAGE NAIC x INSURER A:Berkley Regional Insurance Com 29580 INSURED ROOFK-1 INSURER B:Star Insurance Company Roofing King Inc INSURERC: Craig LaCrosse INSURER D: PO Box 728 Tyngsboro MA 01879 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:677678720 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 I ADDLSUBR LTR TYPE OF INSURANCE I POLICY EFF POLICY EXP POLICY NUMBER POLI MOLIC LIMITS A GENERAL LIABILITY Y Y CGL 0059562-21 12/11/2014 12/11/2015 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TUR—EN—TED PREMISES Ea occurrence $100000 CLAIMS-MADE 1 OCCUR MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEN'LA GGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 JECT IX I POLICY E PRO- LOC $ C AUTOMOBILE LIABILITY Y Y M1T5776F 8/20/2015 8/20/2016 Ea accident $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS x AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident a AUMBRELLA LIAB X OCCUR 000071022 12/11/2014 12/11/2015 EACH OCCURRENCE $2000000 X EXCESS UAB CLAIMS-MADE AGGREGATE $2,000,000 DED I J RETENTION$ $ B WORKERS COMPENSATION WC074279703 8/20/2015 8/20/2016WC STATU- X OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Roofing(commercial and residential)and siding operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Roofing King Inc ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 728 Tyngsboro MA 01879 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD '4� CERTIFICATE OF LIABILITY INSURANCE °/13/2 °15 3/13/2015 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 endorsemen s. PRODUCER NAME: Melissa Warren Risk Strategies Company PHONE . (781)986-4400 FAX No),(781)963-4420 15 Pacella Park Drive E-MAIL Suite 240 INSURERS AFFORDING COVERAGE NAIC sq Randolph MA 02368 INSURERA:SCottsdal@ Insurance Co INSURED INSURERB:Guard Insurance Group Junior T F Construction INSURER C: 406 Bridge Street INSURER D: #3 INSURER E: ,Lowell MA 01850 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1531391061 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. ILTR TYPE OF INSURANCEAIM im POLICY NUMBER ADULSUBR POLICY EFF MMIDPOLID YYYI EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE FOOCCUR CPS1914893 /11/2015 /11/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- JFCT F-1 LOC $ AUTOMOBILE LIABILITY COM13INED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC) I I RETENTION$ $ B WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N LIM TER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1QQ QQQ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) 2W627911 /11/2015 /11/2016 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Evidence of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Roofing Ring, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 12 Malvern Avenue Tyngsboro, MA 01879 AUTHORIZED REPRESENTATIVE Michael Christian/MSG ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD Mass8Ghusens De ■:r*imer+.r of Ru iic 5aFa2,. /Ja r r armr�irr•ct%//t r,/ IIu.,,,.rrht,,.rl, Board of Building Regutzituor, ano Star%daruz; P Office of Consumer Affairs& Business Re?uIstion 0mitructi+)n Supen iwr 1 & 2 Famih .-R'x •¢TOME IMPROVEMENT CONTRACTOR L;cense CSFA-10ib15 x..., iRegistration: 173117 Type: rj =`-, %_`'expiration: 9/4/2016 Private Ca rPoratic CRAIG A LACROSSE. RdOING KING INC. SSS F 12 MALVERN AVENU TYNGSBORO MA Oltj$$ �" ' CRAIG LACROSSE 12 MALVERN AVE. <s%;1 �d•� •:xp TYINGSBORO,MA 01879 1'ndersccrctary er±xssr,5.nne 46/25/2016 Roof q King Inc 41,41.0 t04*W OcCLX-tzn:I Slaw CAI N. -21-N"fh4hn Comm..11 J``•'` CC7t.*t7tSii',A S ; to I �. eLca S5 {fr`.:.�.:r rw.:,;ra-w'ir►t cr fi�j,ai�"` jCoc., �:`.J '� w � E