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HomeMy WebLinkAboutBuilding Permit #1084-15 - 170 PLEASANT STREET 6/22/2015 4, " �UF N0RT#1 E q BUILDING PERMIT ~°0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION D_l Permit NO: Date Received 2I� Date Issued: � SACHUs IMPORTANT: Applicant must complete all items on this 2age LOCATION n S-+- Print PROPERTY OWNER - 1 &-Z-A-&0 Print MAP NO: 06 PARCEL: ZONING DISTRICT: Historic District y no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family 0 Addition ❑Two or more family ❑ Industrial 0 Alteration No. of units: Q,Commercial QAepair, replacement 0 Assessory Bldg 0 Others: 0 Demolition ❑ Other 0 Septic ❑Well 0 Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer 011A (U CLQ coc-- P--o pC--TW R ec Vc. (wY Identification Please Type or Print Clearly) OWNER: Name: A\Y-�,P ctu Phone: q?&-335- OT3J Address: Q gl-easan-� s - raj o,(A-h . CONTRACTOR Name: Phone: Address: �'U (�c�x 7�f� �Uta►Shrrro m� C31� 79' Supervisor's Construction License: Exp. Date: 9bl y K- Home Improvement License: Exp. Date: 0 Co y ARCHITECT/ENGINEER Phone: r Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ D 41&('03 FEE: $ kWO Check No.: I I ala 1 Receipt No.: 7"S3e NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted.❑ _ Plans Waived ❑ Certified Plot flan Tl ' Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f Public Sewer ❑ Tanning/MassageMody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster 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 t - Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signaifure Date Driveway Permit I DPW Town Engineer: Signature: FIRE DEP Located 384 Osgood Street i ARTME-NT �Te 3 TIME- € , mp�Dumpster on site E Located;at 1241MaintSt�eet � Fire:Departmeit sanature COMMENT>S. - - 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 Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 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 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 ✓W� G� No. 1 —�` Date . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $�� Other Permit Fee $ TOTAL $ M Check# � Building Inspector NORTH own Of � _E ndover O .� 0 b Z �— o�h ver, Mass, ol" COC NICNl WIt K A�RATEO MPP�,�y S U BOARD OF HEALTH a PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... S� r�jD BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .. .. p.....Pit:J!+MT......Sir.......................... �n� Rough to be occupied as ....... . .......T......U..'! Dy�— .......................... ...............................icat....... Chimney rmit shall in buk respect conform to the terms of the application Final provided that the person accep�t�r(g this pe ry p p 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 MON HS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION/81P S Rough 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. 'G NJ WG"k Cralg LaCrosse-owner • CONTRACTS PO Box 728,Tyngsboro MA 01879 May 25,2015 978-580.7376 uaig@roofingkinginc.com Customer: Alberto Sobrado Address: 170 Pleasant St.North Andover Postal Code:01845 Phone: 978-335-6535 Fax: ALL Email: 91U1ky05@gmaiLcom an you fora ow ng 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 -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,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 HO 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 -Deck Armor in place of Rhino liner $400.00 Not Included -Timber-Tex Caps in place of Seal-A-Ridge Caps $250.00 Not Included Warranty Roof comes with 50 Year Weather Stopper 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 and building permit if required and c6titract may act as signature for permit. (Any additional work will require separate pricing) Make all checks payable to Roofing King Inc Total: $25,363.00-W0 Act Fast Coupon(Exp.4/31) $24,863.00 Deposit(due at signing): (1/3) $8,288.00 2nd Payment(due when material is onsite): $0.00 Final payment(due upon job completion): (2/3) $16,576.00 SHINGLE COLOR: i Initial: As �8 1 ACCEPTANCE OF P O OSAL u s Znsn con i ons are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment vAll 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$54)per sheet. Disclosure:Customer respGns to co any valuable items in the attic to protect from debris.Roofing King does not assume responsibility for acts of Mother Nature. W OU Owner/Co ctor 4,rope Ow .r Craig LaCrosse ,Albert Sobr do { The Commonwealth of Massachusetts Department of Industrial Accidents 0 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia «'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/OrganiMion/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.Q 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. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.r_1 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole l l.O Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p 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.❑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. :Contractors 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:8120/15 n Job Site Address: )1 C) 0,e_Q S&r\A S-� City/State/Zip: WC&n (lYNA C9 SLk (Y) 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: G2 3 1 Phone#:978-580-7376 Oficial 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#: ®166� CERTIFICATE OF LIABILITY INSURANCEDATDMfYY) A6 RO L6/11/2015 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 CONTACT NAME: McSweeney&Ricci Insurance Agency, Inc. PHONEExtAXIA/CNo)-.781-843-8807 420 Washington Street E-MAIL P.O. Box 850984 ADDRESS: Braintree MA 02185 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Berkley Regional Insurance INSURED ROOFK-1 INSURER B:NaliOnal GranQe Mutual 14788 Roofing King Inc INSURERC:Star Insurance Company Craig LaCrosse INSURER D--Atain SpeciaU Insurance Comp 12 Malvern Ave Tyngsboro MA 01879 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1560669311 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS j LTR POLICY NUMBER MM/D MM/DD A GENERAL LIABILITY Y Y CGL 0059562-21 2/11/2014 2/11/2015 EACH OCCURRENCE $1000000 D X CIP229932 /28/2015 /28/2015 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 IX7 POLICY PRO LOC $ B AUTOMOBILE LIABILITY /20/2014 /20/2015 Ea accident $1,1100,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ NON OWNED Peraocident X HIRED AUTOS X AUTOS A UMBRELLA LU18 X OCCUR 000071022 2/11/2014 2/11/2015 EACH OCCURRENCE $2000000 X EXCESS Like CLAIMS-MADE AGGREGATE $2,000,000 j DED RETENTION$ $ C WORKERS COMPENSATION WC0742797 /20/2014 /20/2015 WC STATU- X OTH- AND EMPLOYERS'LIABILITY y/N I TORY LIMITS ER ANY O FICER/ EMBERIETOR EXCLUDED?ECUTIVE� N/A E.L.EACH ACCIDENT $500000 j (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) l Roofing(commercial and residential)and siding operations covered under Berkley Regional policy I Snow removal operations covered under Atain Specialty Insurance policy 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 Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St North Andover MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD A� CERTIFICATE OF LIABILITY INSURANCE 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(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: Melissa Warren Risk Strategies Company PHONE (]B1)9H6-4400 FAC Noi.(781)963-4420 fAI 15 Pacella Park Drive E-MAIL ESSV Suite 240 INSURERS AFFORDING COVERAGE NAIC 9 Randolph MA 02368 INSURERA:SCOttsdale Insurance Co INSURED INSURERB:Guard Insurance Group Junior T F Construction INSURER C: 406 Bridge Street INSURER D: #3 INSURER E: Lowell MA 01.850 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 INSURANCE POLICY NUMBER ADDLSUUR MM/DDI EFF IPIO EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE FxOCCUR PS1914893 /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 JECT PRO LOC $ AUTOMOBILE LIABILITY MBINED IN LE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA L14B HOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION I WC STATU- I OTH- AND EMPLOYERS'LIABILITY y/NLIM ER ANY PROPRIEfOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) R2W627911 /11/2015 /11/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 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 apace 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 King, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 12 Malvern Avenue Tyngsboro, MA 01879 AUTHORIZED REPRESENTATIVE Michael Christian/MSG ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD Massachusetts -Department c` ?u!)nc Saf::t-r //,, r ,r,,.,..,fret-•(I/m I/ /l<rr-,•,hr..,i/, Board of Butld mg Rc^y:ri t#ons arc Standards Office of Consumer Affairs& Business Regulation Constructiim Supenimr 1 & '_isnmilN _, 'i+7+40ME IMPROVEMENT CONTRACTOR T e: Lscense CSFA-101415 4 }- 112e9istrat+on: 173117 Yp _s "'Expiration: 914/2016 Private Corporatic CRAIG A LACR(OSE ROOFING KING INC. 12 MALVERN AVENW,' TYNGSBQRO MA OtrPCRAIG LACROSSE 12 MALVERN AVE, __.-- � � TYNGSBOP.O,MA 01879 Undersecretary =.;tss csr�w 06/2512016 • i R004N ting #etc za v r Q2fZft 3 3 S0#wur E?cct t,or t Sa!^ty> Si f '�s .tt�tt$'Cou".1 s~+ y C17-RF ED C.armftdWn ftda'j and Ha.'i!t •' to 4 LCL, t `:ar -Print ter tyy33 tCotr l �—