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HomeMy WebLinkAboutBuilding Permit #273-16 - 21 PERRY STREET 9/2/2015 OORT4► BUILDING PERMIT ,�� b6;:f. ,"'h'•�6 °o TOWN OF NORTH ANDOVER ° o APPLICATION FOR PLAN EXAMINATION �* Permit N0: Date Received CH Dat Date Issued: CA e IMPORTANT: Applicant must complete all items on this page LOCATION �� , _T yet�z, .1 Print PROPERTY OWNER___ Print MAP NO �PARCEL:5—,J ZONING DISTRICT: Historic District yes Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building N-CSne family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain 0 Wetlands ❑ Watershed District ❑Water/Sewer I Identification Please Type or Print Clearly) i YP Y) OWNER: Name: �„� � `► ��.�Ji Phone: I Address: 'P yr-S(Nrl 0-8 CONTRACTOR Name: Phone: q 7 Address: Ti4r-(,tiS�rI_i� l Supervisor's Construction License: � Exp. Date: Home Improvement License: Exp. .Date: 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: $ 7 FEE: $ 00 Check No.: Receipt No.: NOTE: Persons cont cting iWth unregistered contractors do not have a s t h guaranty fund - C°1.o�-�-e._ Signature of Agent/Owner Signature of contractor dv i _ Location Date . • TOWN OF NORTH ANDOVER UXW • Z Isy Certificate of Occupancy $ r Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ Check# � E, C�4 2 7 2✓ 2 Building Inspector G . NORT#1 own Of ? E ,. Andover . to No. h ver, Mass A-9 coc"Ic«!WICK 1' S V BOARD OF HEALTH Food/Kitchen MIT T Septic System PER LD THIS CERTIFIES THAT ........ skta.).N.W..'.... ... ....�,..~ .... BUILDING INSPECTOR Foundation has has permission to erect .......................... buildings o .l......... .. .. . A4...P......... ..�..... Rough tobe occupied as ............ ... ........ ...... ... .. .... ..A ...................................................... Chimney provided that the person accepting t permit shall in every respect c form 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 • PERMIT EXPIRES IN 6 MON S ELECTRICAL INSPECTOR UNLESS CONSTRU S TS Rough Service ........T ..................................... .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinje 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. V"044 Craig LaCrosse-owner • CONTRACT PO Box 728,lyngsboro MA 01879 August 31,2015 978-580-7376 Craig@roofingkinginc.com Customer: Satish Tkalapialli Address: 21 Peterson Rd,North Andover MA Postal Code:01845 Phone: 508-329-4713 Email: tsatishchandra@gmaii.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 -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 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 -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 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: $8,000.00-$500 Act Fast Coupon(Exp.8131) $7,500.00 Deposit(due at signing): (113) $2,500.00 2nd Payment(due when material is onsite): $0.00 Final payment(due upon job completion): (213) $5,000.00 SHINGLE COLOR: . L.Q �,P„� Initial: ACCEPTANCE OF PROPOSAL.The included specifications 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 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$50 per sheet. If this account is collected through legal actions,customer will be responsible for all attorney fe nd court vests. D' losur uustto�.meerpresponsible to cover any valuable items in the attic to protect from debris.Roofing King does not assume responsibility for acts of Mother Nature. Owner/ContractOf Prope! Owner Craig LaCrosse Satish Takalapalli The Commonwealth of Massachusetts = Department of Industrial Accidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 M r 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): 1.0 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.] 3.E]I am a homeowner doingall work myself t 9. ❑Demolition y [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs "These sub-contractors have employees and have workers'comp.insurance.: ✓ p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 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. i 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 workerscompensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:Star Policy#or Self-ins.Lic.#:WC 0742797 Expiration Date: 2 Job Site Address: (�'� r`!��F�� r2� City/State/Zip: !'lie) Of c%t 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 Si ng ature_L ¢`'` 'L°�`t�" Date: 3 Z15— 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#: A6CERTIFICATE OF LIABILITY INSURANCE D /DD/YYYY) 8/20/01220101 5 `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: McSweeney&Ricci Insurance Agency, Inc. PHONE FA AIC No: 420 Washington Street MAIL -84 -8600 1 - P.O. Box 850984 ADDRESS: Braintree MA 02185 INSURERS AFFORDING COVERAGE NAIC p INSURER A:Berkley Re0ional Insurance Com 29580 INSURED ROOFK-1 INSURER B:Star Insurance Company Roofing King Inc INSURERC: 14788 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MWDDIYYYY) IMMIDDIYYYYI LIMITS A GENERAL LIABILITY Y Y CGL 0059562-21 12/11/2014 12/11/2015 EACH OCCURRENCE $1000000 X CONTED MMERCIAL GENERAL LIABILITY DAMAGE TO PREMISES(Ea Eoccurrence) $100000 CLAIMS-MADE OCCUR MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 X POLICY PRO- LOC $ C AUTOMOBILE LIABILITY Y Y MIT5776F 8/20/20158/20/2016 Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDIx SCHEDULED AUTOS AUTOS BODILY INJURY Per acddent) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident) ccident $ A UMBRELLA LIAB OCCUR C00071022 12/11/2014 12/11/2015 EACH OCCURRENCE $2000000 X X EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION$ $ B WORKERS COMPENSATION WC074279703 8/20/2015 8/20/2016 WC STATU- X OTH- AND EMPLOYERS'LIABILITY Y/N I TORY LIMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? NIA (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 a� . ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACO® DATE(MMIDDIYYYY) 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 endorsements. PRODUCER NAME Melissa Warren Risk Strategies Company PHONE . (781)986-4400 FAX o,(781)963-9420 15 Pacella Park Drive E-MAIL .Suite 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:SCottsdale Insurance Co INSURED INSURERB:Guard Insurance Grow Junior T F Construction INSURERC: 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. LTIR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM/Do 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 $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000:000 X PRO- POLICY LOC $ AUTOMOBILE LIABILITY COMBINED INGL uMI Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOSNON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N I TORY LIMITS ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? F—] N I A E.L.EACH ACCIDENT $ 100,000 (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 I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Evidence of insurance u ance � 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 Massachu6vtts -Department of Pubkc Safely Soarid of Building Re9ttla2ions and Standards Consumer Affairs& Businless Regulation office of Cons Constructicin Supervi%or I & 2 Famil-4 4t�!�.4�+IOME IMPROVEMENT CONTRACTOR '.4-Wji License: CSFA-101415 %1� I .egistration 173117 Type: expiration: 91412016 Private Corporatic CRAIG A LACRO$SE ROOFING KING INC. 12 MALVM AVENW---,41-1 TYNGSBORO MA 8w,'4 CRAIG LACROSSE 12 MALVERN AVE. TYNGSBORO,MA 01879 III 4 Undersecretary Commissioner 06125/2016 Z' Kin '�riic P0 IN Q, f0f 0�0etig .10 owveaw* CAr . Vi > W