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HomeMy WebLinkAboutBuilding Permit #505-2016 - 20 WALNUT AVENUE 10/21/2015BUILDING PERMIT °� ` q `�t�lo ,6• tiO TOWN OF NORTH ANDOVER JjQ5,�� APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: 18I Z 1 1 1 5 RTANT: Applicant must complete all items on this LOCATION C20 A, -z PROPERTY OWNERmGt�t: , bCiC V1 rint Print MAP NO:� PARCEL:tb�33ZONING DISTRICT: Historic District yes((nn Machine Shoa Villaae ves TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration Repair, replacement ❑ Demolition ❑ Septic ❑ Well ❑ Water/Sewer PROPOSED USE Residential Ei�dne family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other ❑ Floodplain ❑ Wetlands �C-C, X06 Non- Residential ® Industrial ❑ Commercial ❑ Others: ❑ Watershed District Identification Please Type or Print Clearly) OWNER: Name: m�`'��-��'J�c-� Phone: Address:(' CONTRACTOR Name: Address: Q 0 &Q �A Supervisor's Construction License: Home Improvement License: Mt Exp. Date: n -)))I Exp. Date: 9 , Ll / ARCHITECT/ENGINEER Phone: 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 © FEE: $ Check No.: 2123 Receipt No.: �MSU L NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ;,-��� ure of contractor _, r . dC(-v I ti Permit No#: ` BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page =et17 � Z q 1• LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes 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 -- - _ -___ _ n, Rood 0 Wetfands T ­ UVatershed Distract _ 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: M Identification - Please Type or Print Clearly OWNER: Name: Address: Phone: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ EE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund a y r V Plans Submitted ❑' Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent 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 COMMENTS Reviewed o Sianature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes R Planning Board Decision: Corn t Conservation Decision: Comments Water & Sewer Connection/Sianature & Date Driveway Permit DPW Town Engineer: Signature: vire uJepartrrme L ,•r COMMFPTTS. L.UL;dLCU JO't lJZ:) UUU OU UUL ENT; - '6rgptDumpster onsite .,yeses �,,: trioa 'i iiSfreet 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 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 No 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 4. Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application �6 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) 4 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 a. 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 2o �0 A �",4 No. V5 Check #�_--:, � 25,562 DateIb 16 1v TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /Building Inspector O U) O N CD CCD. U) v z CD a CD m cn Z Z 2 D O Z O CD N ca 0 W CL cc X m to rt 0 N 2. CL N S N �D o0"o rt a=i 2 N ="• S. � y CD, CD 0 � n 0 O = 0 3 m o S �� N �_ N rD O O T .-•n 0 m WCD � c ca 0 0 = a� N C D O Cl) 'i co = r« N 0 _ O �• 0 ! r (D CD CD -0 -1o O < co W. 00 u): rt CL C0 o Q o °' coQ N < y �� O O < O O O: Q .� W -z CDN r .a CD ch 0 0 to O G art CnC ND O N D CD=A CD rt 0 C �o T N T C N O C �' O D1 C �' T DlC O O C (D '6 O O :70 :- a n (D N N m C N C 3: W m G1 O 22 W m l�. A Z Z p m m % m Z Z to 2 rrl O m r" m A O O �J(liCir.t. �[ckF. %Jei.trtf ` Craig LaCrosse -Owner y� PO Box 728, Tyngsboro MA 01879 978-580-7376 craig@roofingkinginc.com Customer: Mark Halbach Address: 20 Walnut Ave, North Andover MA Postal Code: 01845 Phone: 508-954-2785 Email: halbach.mark@gmail.com ESTIMATE October 8, 2015 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 anv questions or conrernc at the .,­knr r*„a 6 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 (Est. # of layers_______j -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 Felt Buster 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 -Clean all gutters and downspouts (if applicable) -Existing roof will be removed and recycled at Roof Top Recycling (Certified Green Roofer) Job Specifics and 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 Felt Buster $250.00 Not Included kvI,cWB-df 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: $7,700.00 -$500 Act Fast Coupon (Exp. 10/31) $�•2eg,AO 7 6� @ 00 Deposit (due at signing): , 2nd Payment (due when material is onsite): (1/3) $2,400.00 ��3 3 �� Final payment (due upon job coQmpletion): $0.00 SHINGLE COLOR: ra.c(i Initial - (2/3) $4,800.00 g66,00 ACCEPTANCE OF PROPOSAL The included specdications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above and accept all terms included. All disrmntc r,,, «,, k- .,..-_ . _ - -- -- - v =�_• �_� �� nuu"ng rung mc. 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. Roofin oes not assume spo ibility for acts of Mother Nature. Owner/Contractor Craig LaCrosse Property Owner Mark Halbach The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Wiwwmassgov/dia lliworkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P"lumbem TO BE FILED WITH THE PERMITnNC AUTHORITY. AMIcant tnforaration Please print LA►ih1v Name (Business/thwt izatwn/lndivi"): Roofing King Inc Address: Po Box 728 City/State/Zip: TYngsbora MA, 01879 Phone #: 978-580-7376 Are you as employer? Cheek the appropriate box: 1. ®1 am a employer with employers (full and/or part-time).' 2.Q I am a sole proprietor or partneship and have no employees working for me in any capacity. (No workers' comp. insurance required.) 31—]l ant a homeowner doing all work myself (No workers' comp. insurance required.) t 4.[]l am a bo icowncr 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. 5.0 I am a gawrthl contractor and I have hired the sub -colors listed on the attaethed sheet. These sub -contractors have employers and have workers' comp. insurance.: 6. ❑ We am a corporation and its officers have exercised their right of exemption per MGL c. 152, §i(4), and we have no employam. [No worker' comp, insurance required.] Type of project (required): 7. ❑ New construction 8. 0 Remodeling 9. ❑ Demolition 10 [] Building addition I I.p Electrical repairs or additions 12. Q Plumbing repairs or additions 13.[Z]Roof repairs 14. DOther ar.,...wn a.aa %-- wee ni unia mere i u our me section wow snowing their workers" compensation policy information. t Iioineowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that Bieck this box must atteched an additional sheet stowing the name of the sub -contractors and state whether or not those entities have employees. If the sib -contractors have employees, they mast provide their workers' camp. policy number. I am an e n kyer Murt is providing workers' compensation insumncefor my employees. Below is the polky and job site informadom Insurance Company Name: Stag Policy # or Self -ins. Lia #: WC 0742797 Expiration Date:SST/k Job Site Address: 2.c) �� City/State/Zip•_ _ L &Jy. OW -4M)", Attach a copy of the workers' compensation poUcy 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 cerci fy under the «� penakies of perjury fkat the information provided Is trove and;comet i re• a ' �, 7 Phone #: 978-580-7376 Ojj'idat use ox¢. Ido not write in thin area, to he wed by city or tote» 0,01ctaL City or Town: PermitlLicense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Perone #: ,�tcv'ura� CERTIFICATE OF LIABILITY INSURANCEI 8=015 TNS CERTIFICATE 18 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 POLES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sb AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT. I the create holder is an ADDITIONAL. IiSURED, the poky(les) must be endorsed. N SUBROGATION IS WAIVED, subjed to the terms and worts of the policy, certain pokies my require an endorsement. A statement on this Certificate does not Confer H9ft t:0 the Certificate holder in Rau of such s PRODUCER McSweeney & Rica insurance Agency, Inc. 20 Washington P.O. Box Braintree MA 02185 MEM P"OME F ADDRIMMIJ AFFOROING COVEAAOE Moes MUM A IMISUFM ROOFK-1 Roofing King Inc Craig LaCrosse PO Box 728 Tyngsboro MA 01879 sa aER B Star Insurance Cmpany NawmCflaboad Mutual 14788 INSURER D: t'RSIREt E : D1S1RER F r • �-i r « •p. � ! :' cry- : 1. .! �_�1. a.i a :,:l=, 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 CLAWS. Mtrt Am TYPE OF INS RtANCEF—Om AM SUER MEM POLICY U1eT3 GENERAL LL40ILM GENS LtABTM OCCUR Y Y CGL 0058582-21 121112014 12f"M M15 EACH OCCURRENCE $1000000 _ ppamm)8100000 MED EXP one+ $5,000 PERSONAL & AM INJURY $1000000 GENERAL AGGREGATE $2000000 GEN1 AGGREGATE LWAPPLIES PER: PoucY Zr I LDC PRODUCTS - COMPIOP AGG 82000000 5 AurromoeuuAsLrfY ANY AUTO AUTOS rX AUTOS 8D AUTOS AUT Y Y MIT5776F 81200015 Sf2om6000000 i-^ BODILY INJURY (Per parson) 5 SODILYNVJURY(ParamIdMR)HIRED DAMAGE 5 8 Ur 3A UA13 EXCESS LMB X OCCUR CLAS CUM71022 1211112914 12111/2015 EACH OCCURRENCE 12000000 AGGREGATE IZA00,000 DED RETENTION 1 5 B AND EMPLAYERS' LIABIJTY ANY PROPRIETORIPA� Y / N ppFI2� EXCLUDED? FN (yea, in on tn48r OESCRIPTION OF OPERATIONSbelow N / A WCOT4278703 82012045 8f2Q2016 ST TU OTH ER EL. EACH ACCIDENT 8500.000 EL. DISEASE - EA EMPLOYEE5500 000 - EL. DISEASE - POLICY LIMIT I 5500 000 It OP OPEPtATNMlS 1 LDCAIMM 1 V@HXX8 0 MM ACORD 101. Adm RonoltU talmdabi snow spa* Is rogtdrod) Roofing (COmMercIal and residential) and siding Operations. Roofing King Inc PO Box 728 Tyngsboro MA 01879 Awlaii 64 AlRN01112M REPRESMAIFIVE --A VA4 01999-2410 ACORD CORPoRATInft_ An d asm ,-* ACORD 211(2(1Q105) The ACORD name and logo are registered marks of ACORD A� ° CERTIFICATE OF LIABILITY INSURANCE 71 TYPE OF NOURANCE 3�13/20155 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(St AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: N the cerkEBcaie bolder Is an ADDITIONAL INSURED, the policy(les) mint be endgn>flad. ff SUBROGATION IS WAIVED, subject to the terms arul aondOons of the paltclr. certain Poffdes may require an endorsement A statement on this certificate does not confer rtgMs to the w0ficel s holder M lieu of such s . PROPUCER CTNeliaaa Warren Risk Strategies Company=Lm(781) 15 Pacella Park Drive 966-4100 (781) 963-4420 SEUML UABWY E COMMERCIAL GENERAL LIABILITY CLAWS -MADE [j] OOCt7R Suite 240 Randolph NA 02368 094OWS1 AFFORDINGCOVMOE HMO bWJRaRA:Scottsdale Insurance Co WISURED sommBGuard Insurance Gr222 Junior T F Construction 406 Bridge Street #3 Lowell NAA 01850 NISLWAR Ct POWIERD: arallltERe: F: Fw6vmew" rsvMrMM 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. 71 TYPE OF NOURANCE LATGTE A SEUML UABWY E COMMERCIAL GENERAL LIABILITY CLAWS -MADE [j] OOCt7R 881914e93 !11/2015 /11/2018 EACH OCCURRENCE f 11000,000 DAWM ISEs f 90?rMr- MED EKP Om or* pason) f 51000 PERSONAL &ACV WJURY f 11000,000 GENE aL AGGREGATE f 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY LOC PRODUCTS - OOMPIOP AGG f 2,000,000 f AUTOMOBILE q.NaRITY COMMEDSINGLELIM ANY AUTO OWNED SCHEDULED Paean) f BODILY INJURY (PaALL BODILY INJURY (Per a ck" f AUTOS AUTOS MIRED AUTOS AN �VNIED R f f 11118INWA LIAS E%CEBS L" OCCUR CLAWS -MADE EACH OCCURRENCE f TES f A ER B wom m gXNAPElNtAw")IND ANY � ARTIEPoit11lE MORM Y / M OFFICERIMEJABER EXCLUDED? � (Mya�tO�ecry in NN) DESGIR� IPTI OF OPERATIONS Wow NIA 2#x627911 /11/2015 /11/2016 E.L. EACH ACCIDENT f 100,000 E.L.unow DEAF EMP! f 100 000 E.L DISEASE - Pa1CY L4AIT f 500 000 D PT10N OF oPERATpNS / LRl 1ww I VENIC U (AlsAch ACGRD M Ad68M" R=nft ooatA�% u mem spm b m*"q Svidence of insurance L`COTI=^ATa uiv Roofing King, Inc. 12 Malvern Avenue Tyagaboro, MA 01079 AUTHORIZED W01I EMATME Christian/MSR B 188&2010 ACORD CORPORATMN- All rietaba r ---A InDUAs (201006).ol The ACORD name and logo are registered marks of ACORD Wwacohueov"s Deparlurteel V! pubitc Soarl of Butltlinq Regulabonf. ana Comtrwopa Lu*nsa C-11AW A U DWLV�m Tyrocsoocto or 081251" //" r , —"" ou-villi ( "4 offict of Consumer Affairs & B§si6ess R4*612608 V*(mE imMVEMENT CONTRACTOR !�"lstrafion: 173117 Type, *XpimWn: 9J412U18 Pnvate Corpoiatic ROOFING KING INC. CRAIG LACROSSE 12 MALVERN AVE TYNGSBORO. MA 01879 vadrrwretary 101-1 SEP., �7 WWI. P, Ulc Jr" ......... ........ J