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HomeMy WebLinkAboutBuilding Permit #442-16 - 25 LINCOLN STREET 5/1/2018 C;C',7�t//�ED /0�i3/ /AZP oSA/ 4.,10cj k1 Pd 1—SC" OUILUINU F'tKMI I T UN OF NORTH ANDOVER o APPICA ON FOR PLAN EXAMINATION Permit NO: 2 " �� Date Received n `y 'D SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION oC 5. I YIC�O Y� :S Y PROPER Pnnt TY OWNER_ . �A t 1'1.2 ak'1V'i ' ' Print MAP NO: PARCEL' ZONING DISTRICT::;'- Historic District ,yes no , _ Machine Sh'4p.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 Wetlands ® Vllatershed- ❑ Septic ❑ Well 0—Floodplain © District, Water/Sewer +gyp 4 V- v Identification Please Type or Print Clearly) OWNER: Name: n ,Q, Phone:91 /Stl-� -741- Address: 74JAddress: CONTRACTOR Nam Phone I ' '/' Address: Supervisor's Construction.License""' , "� Exp :Date ` � . u _ Home Improvement License D Exp abo te 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: $ x/10 FEE: $ Check No.: �? �4 2* Receipt No.: R qP9 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty�`und g_it-__.i __ �S riature,ofAgent/OwnFer �M Signature of contract4t-�'�' ` r -' BUILDING PERMIT o� taoRrH q '(t TOWN-40F NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h Permit No##: Date Received gcHus���y Date Issued: IMPORTANT:Applicant must complete all items on this page 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 [I Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ _ _ Y __.. _ .tSeptic: ❑'Well; O',F,loodplarn' hWetlantl's ��.Wa`t:rshed D strict ; ®W.ater•'/Sewer - -- -- DESCRIPTION OF WORK TO BE PERFORMED: � t Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.5 Total Project Cost: $ FEE: $ f s Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund lana �� �of�.AaPnt/D��mer� `S�ature�o�f contract©r - - I Plans Submitted ❑ flans Waived ❑ Certified Plot,Plan ❑ Stamped flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swumning 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 4 COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature ®ate Driveway Permit � I DPW Town]Engineer: Signature: Located 384 Osgood Street F,�IRE DEEP� TMI=NY Tem IN 1i w kI« - ' um ster���'. site es fix ,. R} ,, .� ,,, �. Lated at"124 Maui Street Fire Depament s g store/dateq { M1 =�'i+'.�"' ►.a' 1 t{ *' "yam t �. y _.- «,P� -Y*t4'rr 177 `G®MMENTS : fr.F �+ irti,q ts � r i-s 'S.x 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: lies No MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NOTES and DATA— (For department Buse) I ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 I 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 f 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 Doe:Building Permit Revised 2014 Location �J Na c Date � �� • - TOWN OF NORTH ANDOVER. Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check# 29483 /- Y Building Inspector NORTH own of t E �, ndover O - ;;: 0 No. *y : t L .2 y h ver, Mi� o�C > Mass, / A- COCKIC Kl W#[K y1• 1S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT ....... / . '. ...! .C-.... t:. ..................................................................... .......... �� ������ Foundation has permission to erect .......................... buildings on ............................................................................. ... Rough to be occupied as ................_Svi '�...^.....r�'F.. .:. ...... .... !.� s .................................................... Chimney provided that the person accepting this permit shall in evel respect conform 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 BuildingsIn the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough �.fService .—..—"1................. ................ ....... ..... ...J 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. Page No. of Pages proposal Builders License # 58443 Home Construction Reg. # 167338 o (781)944-1994 (978)664-2557 READING NORTH READING P.O. Box 637, North Reading, MA 01864 Please visit us at www.duvalroofing.com PROPOSAL SU MITTED TOrr �� C_ LDATE6 R / -( 1i2(?, LC G✓! } l STREET r j CI VATE AND ZIP CODE I ( / V!'r 4 a� 011 C'f C`Jt"I We hereby submit specifications and estimates for the items checked in boxes below:- E6 4,fe ' fool _- - ---- _. .----_ - - - —- -_....... ..... — ---_. ip& Remove all existing roof related 72rlayers 's from roof as well as job site with our own disposal truck. NO DRIVEWAY DUMPSTERS ❑ 1 layer'of-existing roof shingles of existing roof shingles ❑3 layers or more of existing roof shingles-__- --.._. Replace any damaged roof decking; not to exceed 32sq ft_ (additional at$1.70 per sq.ft.) - _._ _.. -- - .- . - --- Install 8"Aluminum Drip-edge/Rake-edge along. (Choice o DhitBrown or MITI) -. . 0 I stall ICE&WATER UNDERLAYMENT on all horizontal eaves,sidewalls, skylights, chimney flashing and valley areas ... ......---- -- Install a premium base sheet underlayment(felt)that is in compliance with the asphalt shingle manufacturer chosen by the homeowner _ ......_ _....- - _ _ --- Install The Homeowner's Choice of the selected Tamko/IKO or GAF Limited Lifetime Architectural Roof Shingles ' S See individual manufacturer's warranty for specific details or please call us with any questions --f.......— _.._.__.._ .._'..............--- ------ _ _.. _..-_ .... ..- ........ .--- - �eplace all existing bathroom louver and/or exhaust pipe(s)with new aluminum flanges ---._. _.. _._ ..-- ...._.. -...... Chimney(s)-counter-flash and re-step existing flashing ❑Cut& Install new lead flashing -- .__.--- _- .._....... - -- - _..._ . . ....... .._. nsl tall a continuous low profile Ridge-Vent on all ridge lines ❑Soffit-Vents ❑Roof Louver-Vents ..................- - . _-_.--_---- ---....__....... ......- ❑Seamless Aluminum Gutters-Custom fabricated on site with our own gutter machine ❑ Downspouts at additional ❑Leaf Guards - _ - ........-.........------— _- ._. __ ❑Attic Insulation- Increase existing R.value to R. value with our own blown-in insulation machine exclusively using .......-._ __ _.---- _ -- ---. . .....- ...... ---- ............._ GreenFiber cellulose insulation 0 Other - --- -- - _ _...... __ ...........-- - -- ..— f , rP, l`'�f % _Sttt , .ltL / . /�trG � if 1c�_"f ,,_�, f �t...t�P (�4f /�/� ! ...--- mm...'... _1_r I ' �I._. .L _L_! t- �i i 7 //1 i a !� f: 7�� 1. _- ✓ r 1 f - -- i , l;...f f�' __.._.............. ;I / T—moi_._ _..- _..... *Please cover all items of value in attic to protect from dust and debris W/ e Propose hereby to furnish material and labor-complete in accordance with above specification//s,for the sum of: b '"', Total price not including options. dollars($ /I, y9 0 ). Payment to be made as follows: s, 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments o6t to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Final Payment is due upon day of completion and is subject to the Authorized 1 supplemented Terms&Condition sheet when scheduling. Signature u THIS PROPOSAL IS VALID FOR r DAYS DUE TO FLUCTUATIONS IN MATERIAL& DISPOSAL PRICES. i .gc.vxc� CERTIFICATE OF LIABILITY INSURANCEUAIti, /122/UUU/T15TTT) 3 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 endorsement(s). PRODUCER CONTNAME, Barbara McDonough Gilbert Insurance Agency, Inc. PHONE . (781)942-2225 FAX (?81)942-2226 137 Main Street E-MMEADDRS.bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURER A:Harle sville/Nationwide 26182 INSURED INSURER B:Pl outh Rock Assurance Corp. 04154 Duval Roofing, LLC. INSURERC:Travelers Ins. Co. 0031 P.O. Box 637 INSURER D: INSURER E: North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER CL1411601329 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 ADDL SUBR POLICY EFF POLICY EXP LT POLICY NUMBER MM/DD/YYYY MM/DDN Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE O RENTED 100 000 PREMISES Ea occurrence $ , A CLAIMS-MADE ExIOCCUR GL00000064158G 10/23/201410/23/2015 MEDEXP(Anyoneperson) $ 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 POLICY F1 PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 500,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED RCOOOOIO03799 10/23/201410/23/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Uninsured motorist BI split limit $ 100,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C .WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE PSUB-023ON91-9-15 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) /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 space Is required) Evidence of Coverage I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR A/`/1Qf1 71z/7A1A/ASI (,;l t022-0AIIA A/`/1Qr1(N'100/10AT1/1A1 A11 Ai h#c rncer..ai The Commonwealth of Massachusetts W Department of Industrial Accidents m d I Congress Street, Suite 100 Boston,MA 02114-2017 www mass gov/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): Duval Roofing LLC Address: P.O. Box 637 North Reading, MA 01864 978-664-2557 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): l.a I am a employer with 10 employees(full and/or part-time).* 7. []New construction In 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.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 Building addition 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 11.[]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑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.1 6.F1 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 41 must also till 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 Travelers Insurance Company Name: _ Policy#or Self-ins.Lic.#:7PJUB-023ON91-9-15 Expiration Date:3/9/16 Job Site Address: 25 Lincoln St City/State/Zip: No Andover 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 Sianature: Date"( /"( /1 5 Phone#:978-664-2557 I Official use only. Do not write in this area, to be completed by city or town official. i 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#: 0 N (n X C4 W &//e 16 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5 170 .2 O Boston, Massachusetts 02116 o t CL 9 1 Home Improvement C W Z r� Contractor Registration 0) > Registration: 167338 Type: LLC OW c 0 E Expiration: 9/10/2016 Tr# 256221 DUVAL ROOFING LLC. ca U 0 =4 KENNETH DUVAL Z Z P.O. BOX 637 J 0 eq Z NO. READING, MA 01864 U pdate Address and return card.Mark reason for change. SCA 1 0 20M-05/11 -J— Address F j Renewal E] Employment Lost Card