HomeMy WebLinkAboutBuilding Permit #677-2016 - 180 LANCASTER ROAD 12/1/2015BUILDING PERMIT
TOWN OF NORTH ANDOVER
rn APPLICATION FOR PLAN EXAMINATION
Permit NO: X11 I Date Received
Date Issued: i lv_�
IMPORTANT: Applicant must complete all items on this
LOCATION _ 1 2S0 L An"_:ate
i Print
PROPERTY OWNER �`Ti�e 1
Print
MAP NO: PARCEL: PO ZONING DISTRICT: Historic District yeno
Machine Shop Villaae vesf no
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 ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
S&L(tQ re-aoJ-
OWNER: Name
Address:
CONTRACTOR
Identification Please Type or Print Clearly)
J6(!fA Phone:
Phone:
Address:
60
Supervisor's Construction License: Exp. Date: _ r' -7
Home Improvement License: Exp. Date:
tad 215 2- %- t&
s
ARCHITECT/ENGINEER Phone: t'
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: $ ®• c o FEE: $ Z7i�
Check No.: 461 T Receipt No.:1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signpture of Agent/Owner Signature of contractor
NP
J
Q
S
DZ
OC
Q
m
N
LC
O
LL
E
TO
N
O.
V)
O�
W
Vaf
z
z
0
J
m
a
7
LL
O
o
K
cu T
C
:EC
U
LL
O
W
tail
z
o0
J
d
L
7
d'
C
LL
O
a
of
z
Q
U
W
W
L
�
K
U
N
N
ca
G
LL
0
U
a
z
H
Q
L
. j
O
d'
(O
C
U-
z
W
W
O
W
25
N.
N
i
>
CD
O
Z
N
L
N
0
Y
O
!n
w
z
R
a
GZ
co O
Z
LU
x
NO
U
U)
cn
Lu
ILJ
0
I
;v
CD
E
CD
OC O
O CD
Z
0 =
AI` O .�
W Q
CD
,VAI /W •�
CL r iJ
O =
O 4)
v O
L-
m Q
CL 0 C
c Q
.�
_v J
�CL O 'y4)
rZ W
O
U cU
ca
cc
Q.
is
••
= i
O R
v
.Q
Q. ai
d Q
O
v
U)
J4
E Q
L N
•
D _
w
0
w
F
O
O
L
,R
L>
C
�; C
•
c
�a
O
c�CD >
:—�-0
0
_V
c
cn
m
C
m O z
CL c �..
/.�
�Noo
L
Q CL
N i=
cn
F-
Q
V
L
O c =
L m
I-
�
Q
2 m
co
=
U) N
- O O
W
•0
d
LL
'y
� N C
•C O
V V
uj
5
m
O
N
N
N •> = C
-0 0
R
a
GZ
co O
Z
LU
x
NO
U
U)
cn
Lu
ILJ
0
I
;v
CD
E
CD
OC O
O CD
Z
0 =
AI` O .�
W Q
CD
,VAI /W •�
CL r iJ
O =
O 4)
v O
L-
m Q
CL 0 C
c Q
.�
_v J
�CL O 'y4)
rZ W
O
U cU
ca
cc
Q.
is
Customer/Homeowner Name Company Name
Joel Myerson Precision Rooting. LLC
SIA .HIC # 130275. exp. 2191201.6
Street Address/Jobs to
Contractor/Business Owner Name
180 Lancaster Rd
Erik Hatnmar
T A CSL # 99691 (RF. WS). exp. 10/1712015
City/Town State Zip
Business Address i
� 550 Newtoi\n Rd Suite ] 1 a- Litiletort. MA 01460
'North Andover IMA 01450
DaN-time Phone
1 Mailim Address
Evening Phone
as0 Newtown Rd Suite 115- Littleton. MA 01460
joal@esafetvinc.com
Business Phone
' 978.635.1023
Federal Emplo-ver ID
20-2820250
WORK TO BE PERFORMED AND MATERIALS TO BE USED
Contractor agrees to do the work. and to furnish the materials. described below for Homeowner:
• Acquire all necessary- permits.
• Install tarps prior to shingle removal to protect the house. landscapin becks and A/C units.
• Strip off all old shingles from roof. de -nail substrate and repair/replace rotted boards.
• Tail off any loose substrate sheathing.
• Install .Premium .018. 8 -inch mill finish aluminum drip edging along all roof side (rake) edges.
• Install new mill finish aluminum vent pipe flanges.
• Leave in place and re -use existing aluminum .step flashing where rooflines join vertical walls.
• Install new aluminum flashine. around chimnev under/behind exiStitlg lead flashinO.
• Inspect existing lead chimney flashing for adequacy with Contractor's 10 -year Warranty.
• Install CertainTeed ridge vent at all ridgelines. per manufacturer specifications.
• Apple a 6 -foot width of CertainTeed `(Winter Guard' underlaynient as folloNvs: alone roof bottorn
edges: up valleys: around skylights, chimnel- and gent pipes. Application will extend under existing.
step flashing.
• Install CertainTeed Diamond Deck synthetic underlayment over remaining exposed sheathing.
Installation will extend under existing step flashing.
• Install CertainTeed Landmark Limited Lifetime architectural roof -shingles of select color.
following manufacturer's application specifications. `
• Install CertainTeed Swift Start factory enhanced starter strips along eves and rakes and factory
enhanced Shadow Ridge, ridge cap. Increasing wind warrantee to 130mph.
• Fasten roof shingles with six hails per shingle following manufacturer's nailing pattern. Nails are
galvanized steel 1'1/4'' by 1/8" smooth shank with 3/8" diameter head. No staples will be used.
• Clean and sweep jobsite daily with a magnet.
• Remove old shingles and related debris from job site.
• Clean jobsite grounds upon completion of all workdescribed.
• Leave two roofing bundles for home owner whenjob is complete.
irurreuanrr"a Initial..OZA- + i of—, Contractof.Initials ,9A
OTHER CONDITIONS,_WARRANTIES/GUARANTIES, WORK SCHEDULE
• Work area to be completed is the entire roof. Exposed .areas will be protected from inclement
weather.
• Total Contract Price includes replacement of two =1 -foot x 8 -foot sheet of plywood if needed.
:Additional plywood replacement will be S50.00 per 4 -foot x 8 -foot sheet, installed. Thickness of
replacement plywood «will match existing substrate sheets.
• "Total Contract Price includes disposal fee for old shingles and related debris.
• CertainTeed's Limited Lifetime Warranty on shingle materials is per Homeowner's registration
available online at Av.-w.Ceriainteed.com.
• Total Contract Price includes Contractor's 15 -year Warrant= on labor covering an,,: leaks associated
with poor workmanship: chimney -roof flashing joints, loose sheathing,. raised nails. low nails.
sunken nails. bent nails; improperly installed ice and rater, paper, or shingles (Nvarranty does not cover
extreme acts of nature).
• Precision Roofing. LLC is not responsible for existing hidden damage. excessive rotting etc., and if
discovered xvill cause all work to cease until there is an agreeable solution between both parties.
+ Permit cost vary greatly from town to town, permit cost will be additional to the final bill
based on vour towns rate.
+ The jblloiving schedule will be adhered to unless circumstances beyond contractor's control arise:
NN'ork Scheduled To Begin: 11 `9 2015 \ ork Scheduled To End: 1 l t{)!2{)15
the elates above are ballpark time frames. Ali exact date will be given upon the return of this contract.
PRICE AND PAYMENT SCHEDULE
Contractor agrees to perforin and warrantee the work, plus furnish the materials and labor. as specified
above; for the SUM of.
Good/ Landmark: S18.400.00
l-lomeo-,vner agrees to make payments according to the following SCHEDULE (Cash. Check. Visa.
MasterCard. American Express and Discover are accepted): l:\mtrican l pres. tisill he :ubicCt it, 1.5`0 "urchary)
113 upon signing the contract.
213 upon completion satisfactory to all parties of all work described herein.
All home improvement contractors and subcontractors shall be registered in .Massachusetts. inquiries about registration
should be directed to: Office of Consumer Affairs and Business Regulation
Suite 5170. Ten Part: Plaza. Boston. MA 02116: 617.973.8700
Homeowners who secure their own construction -related pennits or deal with unre=gistered contractors shall be excluded
from access to the Guarantee Fund. v
A cop} of this contract will be kept by the Company and should also be kept by the Homeowner.
DO NOT SIGN THIS CONTRACTIF THERE A.ItE ANY BLANK SPACES
4n, gzn hf
f m ,me s Signature,,; ate Cantractor s 'i nature I)tfte
Y41oineowner may cancel this agreement if it has been signed by a party thereto at a place oiher than an address of
the seller. ,Which may be his main office or branch thereof provided Homeowner notifies the seller in writing at
his main office or branch by ordinary, mail posted. by telegram sent or by deliver\•, no later than midnight of the
third business day following the sienine ofthe agreement.
Precision Roofng. LLC tNr,NF -.precisionroofinp-llc.com
2 of 2
The Commonwealth of Massa. chusetts
Department of Industrial.ACCidents
.I Congress Street, Suite 100
==' Boston, MA 02114-2017
www mass.gov/dia
sJ• Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le ibl
Name, (susiness/Organization/Individual): r G+^ G 1
Address:,u
City/State/Zi-D:
Are you an employer? Check th"pi•oprlate box:
() tC4 (-) Phone #:
2.A
I am a employer with � employees (full and/or part-time).*
2. I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers comp. insurance required.]
3.. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t
4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.#
6. ❑ We are a corporation and its of�gers have exercised their right o£ exemption per MGL c.
152, § 1(4), and we have no. employees. [No workers' comp. insurance required.]
3
Type of project (required):
7. [] New construction
8. [1 Remodeling
9. ❑ Demolition
10 n Building addition
11.❑ Electrical repairs or additions
12.0 Plumbing repairs or additions
13.oofrepairs
14. Other
*Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information
t Homeowners who submit #his 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:
Policy # or Self -ins. Lic. Expiration Date: f�
Job Site Address -AW) 1 anra �er City/State/Zip: "�
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.
.t do hereby certify under thepains andpenalties ofpejury that the information provided above is true and correct.
N
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
11 Contact Person: Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of liire,
express or implied, oral or written." '
An employes is defined as "an individual, partnership, association, corporation or other legal entity, ox any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth .for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall.
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill -out the workers' compensation affidavit Completely, by checking the'boxes that apply to your situation and, if
necessary, supply sub-contractoi(s) name(s), address(es) and -phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to cavy workers' compensation insurance. If anLLC or LLP does have
employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents fox confirmation of insurance coverage. Also be sure to sign and date the at'fidavit. The -affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if yo'u•are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their
self-insurance license number on the appropriate line. -
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "fob Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
`'ERTWICATE OF LIAMUTY NSU NCS
TNI$ t:ERi7FIGATE IS ISSUED AS NO RUAT'ON ONLY CONFERS !LO R►GHTS UPex!6 THE t
..HOLDER THIS CEIitTF1CATE DD€6 MOOR OF INFD
AFFORDED; THE POLICIES BELOW THISCERTIFi -%Ly OR NE"TIVELY AMEND, tar INSURANCE DES NOT CSD OR ALTER THE
THE ISSUING INSURER(S),AUTHO�O pEPP,E> AJC OR PRODUCER, � A Z:ONTRAc
IMPORTANT.f#the ANDT14r:CER7iFICA�TEjigLM
eerffcs_ helder isan ADDITIONAL INSURED, the 1'
sul fect to the term and aw3diiions oft a fro it'Aies) mustbe endorsed. If SUSROQATIOh
not Conferri his to the I r certain poficies mag regrrrz ars endorsersssrsL t� sistem�nt GIs ihfs Cee
8 oertifuatehaldarinftlofsuehend
n4s}.
WESTFORD INS AGENCY INC CRVTACT
ruin•
PO Sdx 308 PHONE FA)(
WESTFORD. itiA 01886
c., a IdlC. rnr
- MWRED
1
PRECISION ROOFING LLC
1266 NEW ESTATE RD
a3sunE� e:
LIrrLE7tON,MA014E0
Frsu3z:Rc_
AU7a
LvsuRnr� _
trSURERF:
601-91
NA3Cr
TRIS IS TO CERTIFY --- r -IE ••c,aumts K
THAT PERIOD
N I✓C OF INSURANCE LIS ED 9ELOW HAVE BEEN ISSUED TO
ABOVE FOR THE POLICY PERIOD fldf)IC;ATED_ NOTWITHSTANDING A
cQnITRAcT OR QTHER DOCUttEh1TWITH REQUIREMENT. t THE
MY ITE ITISURED AAiED
INSURANCE A.�FORDED BY TH �nESPECT TO W}{)CK TFi3S CERT3F[CATE 1�1AY 8E ISSL)E t3R IVIP,Y P RTA F ANY
CONDITIONS OF SUCH POLICIES_ L!h ITS SHOt'!h; MAYII-U1�E g��� REDUCED $Y PAID ALL THE iERFAS. EXCLUSION AND
CLAIAfS_
COWI'_-q=-' GENEFAL+ I9ealLr7'
EACH OCGURR9iCE
r'OL7CY 1 PRO- I
_ECT 1 )LOC
PR6DEI :-rS. C!]yp:+AQ
� LIIS>31ri•Y
�..TiY
AU7a
� �'cO3�Ei(J�rSUiGCE LA6r
1' -Li. OL.'r. O
!TOS
+
80DILYrrZk7RY
�I A.3'75
(Parpy-.,3,�)
i jr R=_OAUT;DSp
KON'(yvr'-r3
AUTOS
EGOILY3NJlAY Caersr�C2nt3
p
?�P- PJ.LIGE
I
'U-1 OCCUR
�<
J�=14SCL -UMS-9tAOc
I F --CH OCCURRENCE S
DED remoras I
, I AGGREGATE s
A3$lEWLOYFli3`LIABIUTY
IJVY PROPWE, 0�f7A TNc+�..' ECi+l7V=
I xC5T'x;t3..
Tarzr umm
oFc:rz���3aE3t� cLuo-�t y uta
=R
Ir'5aw-y hMrl
6SBOUS IfT1&2I31ti L>61�2016 ELSr4 NACCO&W
v)m&e= c.6-
acs,^raztDnl o=o�aT loxs txr.-..
2EI73492 E-LOiSEASE-cAp!p 0yEF $-
EL-01--=ASE-PouCrU►u $:
i
y' '}+ O?T}.'�2ATIO2i511�ATt SI�SlR�faCuRD YQf..'1da3ynr�1
Zlrw"w ANY OF THE ABOVE OESCRIBED PI
CFlf�t%FLLED BEFORE T14E EXPIPAnDN DATE
HOnCE 1RfLL EE DFLJVERED IN ACCORDANCE
Tru rev oamwe+--
AUTF)ORrizD
RD 2s (20t01ti Tne kc.I1 r�33 ar,d r ®9ssa Z151aRc�n Cpp�oN.
ago a� �egisterad maAcs afaCDRn
3 Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSSL-099691
Construction Supervisor Specialty
ERIK B HAMMAR.
550 NEWTOWN ROAD.
SUITE 115
LITTLETON MA 01460
Commissioner
6F/e ty'iinr�uorrraetc�l� aj��FY.uldac�r�sct/,;
Office of Consumer Affairs & Business Regulation
' HOME IMPROVEMENT CONTRACTOR
_ Registration: 130275, Type:
Expiration 2/9/2016 Ltd Liability Corporati
PRECISION ROOFING LLG
A
1
Expiration:
10/17/2017
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
Erik Hammar. . r f
550 NEWTON RD
LITTLETON,, MA 01460 Undersecretary Not valid without signature
Location / F 6 Z A4, led
No. —7 # — ? ol� . Date
r
TOWN OF NORTH ANDOVER ,
Certificate of Occupancy $
Building/Frame Permit Fee $�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # l bi
1
29762 Building Inspector .