HomeMy WebLinkAboutBuilding Permit #822-15 - 35 EQUESTRIAN DRIVE 5/4/2015AW ' " L� E f10RT►/ '1
BUILDING PERMIT?
TOWN OF NORTH ANDOVER °
��`{� APPLICATION FOR PLAN EXAMINATION �, x
Permit NO: Date Received �,
�9 S
Date Issued: �CNUS
IMPORTANT: Applicant must complete all items on this nate
LOCATION ) oZ �C� uP S16a.n (Jr—
Print
PROPERTY OWNER Lou w2z!4 r Print
Print
MAP NO: I 5 PARCELOVM ZONING DISTRICT: Historic District yes no
Machine Shop Village ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
ire family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alt ration
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
d
Identification Please Type or Print Clearly)
OWNER: Name: L)u �rL� Phone: &- 8 d-7 — to(o �
Address:
CONTRACTOR Name:
ra
Address:
Phone:
Supervisor's Construction License: Exp. Date:
Home Improvement License: ' 3 / C Exp. Date:
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: $ is , (o o u FEE: $ /�-f= 0 d .
Check No.: f6lzy Receipt No.:.9-Algl-��
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
r _ h
Location L ,V
No. Date
Check *031
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $�f
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
1
wilding Inspector
Plans Subrnitt d ❑= Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Nanning Board Decision:
Comments
f
Conservation Decision: Comments
?1/ater & Sewer Connection/Signature &Date Driveway Permit
DPW Town Engineer: Signature:
_ Located 384 Osgood Street
FIRE DEPARTMENT 4�rn Dorn is e
,.� .L,..`�d'p�py,.�on site }yes no�
(Located at�24 ain}Street+ '�'
Fire Departmen �i.g® r�afur�e%d
�!GOMMENTS �_._
D imension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
T tal land area, sq. ft.:
E ECTRICAL. Movement of Meter location, mast or service drop requires approval of
E ectrical Inspector Yes No
® NGER ZONE LITERATURE: Yes No
M . L Chapter 166 Section 21A —F and G min.$100-$1000 fine
ES and DATA — (For department use
❑ Notified for pickup Call Email
ate Time Contact Name
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
a. Photo Copy Of H.I.C. And/Or C.S.L. Licenses
4. Copy of Contract
4 Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
:ae 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
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
IOTE: 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
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Craig LaCrosse -Owner • Contract
978-580-7376 April 6, 2015
craig@roofingkinginc.com
Customer: Lou Wagner
Address: 32 Equestrian Drive, North Andover
Postal Code: 01845
Phone: 978-807-6657
Fax:
Email: wagnerlj@comcast.net
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 ft $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 chimneys and sky lights
-Remove and re -install new plumbing flashing on soil pipes vented through the roof
-Install Rhino Liner 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 1 1/2 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 Seat 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
i
-Existing roof will be removed and recycled at Roof Top Recycling (Certified Green Roofer)
O Tonalpg ar den (on full roof replacements)
-Deck Armor in place of Rhino liner $200.00 Included
-Timber-Tex Caps in place of Seal -A -Ridge Caps $200.00 included
-Weather watch upgraded to Storm Guard Ice and Water Shield $0.00 included -
Replace skylights (2 skylights at $600 each) $1,200 Included
-Replace 2 skylights at $600 each $1;266 *Included
WarranIX
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 ystem.
PAYMENT STR T rR :
This price includes labor, material, trash removal and building permit if required and contract may act a.* signature for permit
(Any additional work will require separate pricing)
Make all checks payable to Roofing King Inc
Total: $16,100.00 4500 Act Fast Coupon (Exp. 3131) $15600.00
Deposit (due at signing): (113) $5,200.00
2"d Payment (due when material is onsite): $0.00
Final payment (due upon job completion): (213) $10,400.00 -
Owner/Contractor
Craig LaCrosse
a!;L 6_?,�111
Property dwner
Lou Wagner
The Contmonwe,alth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Smite 100
Boston, MA 02114-2017
Irl www massgovldia
%1,orkers' Compensation Insurance Affidavit: Builders/CoatractOms Electricians/Plumbers.
TO BE FILED WITH THE pERMITTING AUTHORITY.
Plaut Print I.esiblY
Name (Business/Organization/lndividual):
Address: �Vet"n-
'��° 737
City/State/Zip: n S CN'0 (YMty o)€ Phone #f: n 10.
Are you as empbyarr Cfeek dw xWetid*n bol:
1. Q I am a employer with employees (1`611 ardlor part-time)."
2.01 am a sole pmMdm - pannership and have no employees working for me in
any ceVwity, (No workers' comp. insurance required.]
3.[ I am a homeowner doing all work mysdf V4-work—'comp- insurance required.] r
4.01 am a homeowner and will be hiring contractors to conduct all work on my property twill
ensure OW all contractors either have workers' compensation insurance or arc sole
th no employees.
5. 1 8im ;::: contractor and I have hired the sub-conuacim listed on the attached shed.
These sub-eoixuadm have employees and have workers' comp. insurance.:
6. [ We are a corporation and its officers have exercised their right of exemption per MGL c.
152. §1(4), and we have no employees. lNo workers' comp. insurance required.]
Type of project (required):
7. [] New construction
8. [ Remodeling
9. ❑ Demolition
10 Building addition
11.0 Electrical repairs or additions
12. [] Plumbing repairs or additions
13.of repairs
14. [:]Other
*Any spplimd that dx cks box # 1 smart also filI out the section below stowinglite-[ workers' compensation, ion, policy information
1 Hompawam who submit this afftsiavit indicating they are doing all work and thea hire outside contractors must submit a new affidavit indicating suds
;Contractors that eba«tt this box mast attached an additional shed showing the name of the sub-comnicuxs and stare whether or not those entities have
em ployem If the stub-coutzactors have ennployxs they must provide their workers' comp. policy number.
I em d" eslptoyer that fs pr oWdfng workers' congwnsadon buxrawe for my employees. Below 1s the pOticy avid f ob s#e
fnfarmadoa. �-�-�
Insurance Company Name:
Policy # or Self -ins. Lic. #:yi G o7 4 a-19 7 Expiration Date:
job Site Address: Gity/StateJZip:
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 fire 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 be^* cara►fy X& Me,pairrspp"lury that the info madma pmmWM above is erre amt cao rea
(,1.d A4 r,_....
-737(o
O,Mdat use on&. Do sort tvsfte in this area, to be conrpltted by cit]' or town offid aL
City or Town: Permit/license #
inning Authority (circle ons):
1. Board of Health L wilding Department 3. City/ -'own Clerk d. Electrical Inspector S. Plambing Inspector
6. Other
Contact Person: Phone #•
%upenosor I
CSFA-101415
CRAJG A LACROW
t2 KALYMN
Tyfq;suoao
'. f — I'll ". 1, x!•. " I
unumer Wairs
T440mE IMPROVEMENT CONTRAC�OR Type
4
+egiatration. !"31'7
44 pp,ate coorpole',
Expiration.
,—),0f:ING KING INC
2 MALVE RN
T,14GSBORO MA 01879
1 ndtr%rcrriar,-
t�k,dl-,4
A� a CERTIFICATE OF LIABILITY INSURANCE
; 3/2` o '5
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTMATE DOES NOT AFFIRMATIVELY OR NEGAMELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sh AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE NOLDER.
IMPORTANT: If dee mwdflmsl11 holder is an ADOFTIONAL INSURED, the polcy(ies) must be endome& If SUBROGATION 13 WANED, subject to
the bus mW conditions of the poky, certain policies may require an sndomsemnent A sbtement on fids cerWkate does not confer might to the
cwdf ab h~ in I*u of such a
memLODuc a
Risk Strategies Company
,15 Pacella Park Drive
Suite 240
Randolph MA 02368
Melissa warren
(781) 986»4600 �NA(761)963-4420
AFFO/COamsCavm',(tAGE NICs
wsuReRA:Scottsdale Insurance Co
eaLNm
Junior T F Construction
406 Bridge Street
#3
Lowell Iii► 01850
L mt a -Guard Insurance Group
NSC:
weMD:
pmSbRER E
/11/2016
COVFRAOFS CERTtFfCATE NUMBER--CLIS31391061 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 VMICH 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 SHOYM MAY HAVE BEEN REDUCED BY PAID CLANS.
LTR
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CLAWS -MADE (j] OCCUR
$1916893
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EACH OCCURRENCE f 11000,000
Tr -
s 100,000
MED EXP ane f 51000
PERSONAL &AoV 04JMY f 11000,000
GENERAL AGGREGATE f 2,000,000
GENT AQGREGATE UMR APPLIES PER:
I -xi POLICY El LOC
PRODUCTS - COMPrOP AGG f 2,000,000
f
AUTOMOIL€ I.IIIMLffY
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E.L. DISEASE - PoUCY LMMT 17 500,000
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D m4p%'f erpN ale cwgm. aN3I LOCATIONS I V6401.211 (Amlg 1 ACORD lat. Adedo" ftwnwks sca.ar., If "mm opme in 009004
Svidsncs of imssuranas
Roofing ]Ging, Inc.
12 Malvern Avenue
Tyngsboro, MA 01899
ACORD 28 (2010!05)
Diem (201006).01
SHOULD ANY OF THE ABOVE DESCRIBED POL CIES BE CANCELLED BEFORE
THE EXPIRATION DINE THEREOF. NOTICE VWU BE DELWERED IN
ACCORDANCE Whim THE POLICY PROVISION&
AUT"01UMMOMESMAIM
chael Christian/39EIG
01908 M0 ACORD CORPORATION. All rigtmta reeerved.
The ACORD name and Iogp are regbAerod nnarks of ACORD
CATs offm a w"
►co t� CERTIFICATE OF LIABILITY INSURANCE 2/12aO
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 iNSURERI;S), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER rtpast Ire atldorse4 N SUBROGATION IS WANED, subject to
IMPORTANT: M the certificate hokler is an ADDITIONAL M: the policy( mum
sadorsemot A atatamerlt on this ceNScabe does not confer rtQtiCf 110 the
the tames and condtdorm of the Policy, certain pailcies may rego
—rrilimft holder In lieu Of such 3s
PV40 JM
McSweeney & Ricci Insurance Agency, Inc.
420 Wast�lton Street
P.O. Bax 3984
Braintree MA 02185
"Isu EC ROOFK-1 09040 "
Roofing King Inc INSURER C
Craig LaCrosse _"I D ;
12 Malvern Ave INS E
Tvnasboro MA 01879 . e
COVERAGES CERTIFICATE NUMBER: 1116936831 _ REVISION NUMBER:
THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN {SS(lE0 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODHIS
INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VATH 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 REDUCEDBY PA CLAVAS.ow" Mw --
aMITS
s�R TYPE OF 04SURANCE Jim jM At"
A GENERAL r tAHMlrY Y Y CGL 0058562-21 1
211112014 12f11r2015 EACH OCCURRENCE $1000000 _
O CIP22B832 !28!2015 12812015 $100000
%{ COAptERCV1L GENERAL
�LIABILITY OCC PREMISES a 0�_
CLAIM. I,MDE 1 _►AED EXP {Any ori Pte) $5 OQO
PERSONAL & ADV 04JIIRY E $1000000
LIMIT APPLIES PER:
AUTOMOBILE LIAWLITY T T M1 i W /oil
ANY AUTO
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IIUNOREL IA LAM OCCUR CU0071022
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M opIXE S cOMPENSAWN VIK'A742787
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DESCCRIPIION OF OPERATIONS I LOCATIONS! VEMCLEA (Attach ACOM 101. AdeMfonal ReONU SCIpArM, N IVIM aI ; b r*gWredl
Roofing (commercial and residential), siding and snow removal services
E.L. EACH ACC
ESL DISEASE -
E.L. DISEASE -
CERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TM EXPIRATQN DATE THEREOF, NOTICE V LL BE DELLVERED IN
Roofing King Inc
ACCORDANCE wr H THE POLICY PROYMIONS.
12 Malvern Ave
Aunsn.,
Tyngsboro NIA 01879
�rrsAnvE
s .dann_,%n,in At%r%on ru-Moe ATInN_ All rinMs neservad-
ACORD 25(201=6) The ACORD name and logo arra regbomW marks of ACORD