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Home My WebLink AboutBuilding Permit #499-16 - 56 SUGARCANE LANE 10/20/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: r Date Received Date Issued: 0" 110, 1 IMPORTANT: Applicant must con LQCATION' P— int r- PROPERTY OWNER•�c Pnnt MAP PARCELd ZONING'DISTRIG ,te all items on this page 4t- 1 100 Year structure no eyes ; Historic Dlstnc_# yes ,. +no TYPE OF IMPROVEMENT PROPOSED USE ❑ New Building 11 Addition ❑`Alteration Residential a family ❑ Two or more family No. of units: Non- Residential ❑ Industrial ❑ Commercial m-llepair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Other ❑ Others: ❑ :Septic: ❑ Welly ❑ 1Nater/Sewer' �- -- �- ❑Floodplain, ❑ Wetlands . ❑ vat—ershed bstnct - _ -----•-•• • •...�..+• •.v��n � v oc rCKrVKIVItU: ldentfiicatio se Type or Print Clearly OWNER: Name: Phone: Address: u Contractor Name1 y Q✓ Phone�fwi� 3 :_ Address./ f _ Ve, S �c/ , kh t� g Sup:ervisor's�Gonstruction License1 Exp Date" Horne Improvement License ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost:$ / FEE: $ `Z. Z Check No.: Receipt No.: Z 5 NOTE: Persons contracting with unregistered contractors do not have access to the gu mnty fund Si nature_ of A ent/Owner ,. ° -" - --g g Signature of`contractor____ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature. CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments s` Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit 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 No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email 3 Date Time Contact Name Doc.Building 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 ❑ 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 NOTE: 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 ❑ 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) Li Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 . —,�& Af o Pe. g,_. 6 No. & Date . - TOWN OF NORTH ANDO yJER . _. Certificate of Occupancy $ s Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 �s n 9 Building Inspector el r�rw V[ O E��' 3K\ Q W LL.Z O m C .0 O LL ate+ Ln Y O0 a). N W d z m O td :tLo 7 LL CL E U _ LL W N zco J n' w d' _ @ LL W N z Q V v W W CLO IY N LL O ULn a z Q O IY _ t0 LL z cW c Q W p LLJ °C LL Na L� m z a) V o Y !n E w C DO O Q Q. 0 Q C .M Cc J -0 O m z U) O O o v 2o °Q W L a C0 CL+' z a> Q O c v z G J E \: CLm N �Z ( CL m M •E Cfl O O y W v+ s�Q rn c xZ ..c O W 0 C D: L O Ln 0 y w W 3 a,'> o c W J _0 az CL CD� s m cc '0 N F-° V G = _ Q 4) L cc � o = O Oto : Q W '� V m N d W 61. O N w O O to C �' O cm:E.2 m w LU Ea L -O = O cc O 1— w Q- 0 0 > w C DO O Q Q. 0 Q C .M Cc J -0 O m z U) ESTABLISHED 1985 EXPRESS ROOFING s r Y PROPOSAL www.expressrooter.com HOME IMPROVEMENT CONTRACTORS LICENSE # 109126 CONSTRUCTION SUPERVISOR LICENCE #99497 • • PROPOSAL SUBMITTED TO: DATE OF PROPOSAL11Q 712015 mike@expressraofer, o P,O. Box 542, Chelmsford, MA 01B24 Phone: 978-266-2333 / Fax: 978-251-2907 MIKE STAFF ROOF COMPLETION DATE--- ._ 56 SUGER CANE LN SQ YEAR HOUSE BUILT - 1993 NORTH ANDOVER MA 01945 978-314,7692 yYA,dlefeby�,pyopose to m ��rialsrOndpQr/ormthe_labor„>'►ecessary far the c�pletlon.oP.,• INST.ALL.ANd CUT -1 p ''. X VENTS-ON,ROOF ALSO.URGRADE.RIDGE,VEN,.TTO.OWENS.CORNINGSU'REUEN'f - STRIP ALL ASPK&J SHINGLES OFF HOUSE -WINDOW- GARAGE ROOFS CLEAN UP AND HAUL AWAY TARP OFF HOUSE TO HELP PREVENT DAMAGE TO HOUSE AND LAWN AREA COMPLETELY DE -NAIL OLD ROOFING NAILS AND RE -WAIL ROOFING BOARDS AS NEEDED WITH 8D RING SHANK NAILS ALL WAIL FLASHING WILL BE INSPECTED AND REPLACED AS NEEDED Install: Owens Corning Weather Loa G Pro rade 6 FEET tAR from the bottom eaves Owens Corning Weather Lock G Prograde under chimney lead and down on roof Corning Weather Lock 9-E rade in valleys _Owens Owens Corning Weather Lock 0 Prograde ON ENTIRE BACK ROOM AND PORC ES LSO DORMER SECTION ROOF Owens Corning Weather Lock G Pro rade around vent pipes on roof Owens Corninq Weather Lock G Prograde on roof where roof buts into walls Rhin9Roof Synthetic Roofing Underla ment over roof boards Owens Corning Starter strip on all roof decking ed es , Owens Corninp Trudefinition Duration shingles We install 0 nails per shingle for a 130 mph OC wind warran Cut in 1 1/2" openino on eak of roof and install Owens Corning SureVent along all ridge surfaces (ridge vent is Hand Nailed Owens Corning ridge cap shingles _ 8" Drip edge on all outside roof edges that not have vented dri ed a white New pipe flan es over vent pipes 2"-4" All shin les will beJastened using 1 %' - 1 1/" roofing nails SLOW OFF ENTIRE ROOF AND CLEAN GUTTERS AND DOWNSPOUTS ROLL 3 FOOT MAGNETS OUT TO PICK NAILS OFF LAWN AREA FOR FINAL CLEANUP INCLUDES: ALL LABOR AND MATERIALS FOR THE ABOVE AND ROOFING PERMIT ALL ROOFING MATERIALS STRIPPED OFF YOUR ROOF WILL BE RECYCLED AT ROOF TOP RECYCLING • gamin! 1 1 , 0 w p o tJ ® ti 3�1,,,�,1'�AR LIMITED F�ANS.Idt� VJfA�NT1r' _ �� C� t.��l�E1V,.r�EE�dJC3'.IEL1�f�Q 1 TT:P"`BEL'01Yr1'�" �I¢EEE"1:7PPP�RC� FfAt�L A1MAY ALL SHINta1�ES � u�,� �, t� �3 _ _ _ Note: Ng warranty on prob/ams and /or damaged caused by ioe backups No warregiy 4n old SkyNights All material Is guaranteed to he as spactfied, and the work to be performed In accordance with the drawings and specifications submitted for above work and completed In a substantial workmanlike manner for the sum of.- 1$19,124.00,— NO NONE Y A70WN $ PAYMENT IN FULL AT COMPLETION OF JOB WITH CASH OR BANK CHECK MADE OUT IN THE NAME OF Ex rasa Roofing INC. Call Tall Free Respectfully submitted�T- n i 1-88821 O -ROOF • • • Note -This proposal maybe withdrawn by us It not accepted by: _ 10/14/2016 All workers fully Insured ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. are authorized to do the work as specified. Payments will be made as outlined above. Any additional wo th n the abov will b an extra charge. SignatureDate 11,q SHINGLE COLOR Homeowner is respbnsiblelifor protecting and cleaning content of attic from possible dust and debris during your roofing project. Not rocponalble for any lasuas caused by mold Any 112 In. Plywood installation will be an additional charge of $60.00 PER SHEET Labor and materials Included We recommend new chimney load with all new roofs for an extra charge of $496.00 per chimney - D1 The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Vorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address:_,r� )off S ?,L\ City/State/Zip: \� E,S ('r,\ "c,, c \-Mp Phone #:(C I5(o-a'33-3 Are you an employer? Check the appropriate box: 1.❑ 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 t ,all contractors either have workers' compensation insurance or are sole Za 'tors with no employees. 5. 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 officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Pl epairs or additions 13. oof repairs 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 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. , _ _ n Insurance Company Name: r r G Policy # or Self -ins. Lic. #: Expiration Date: 16 Job Site Address: 56 �J�� City/State/Zip: /\% . 11 C___ 0) y . 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. Ido hereby certify under thin d penalties of perjury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # bb -0 Ji f' 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 #: ACti D' CERTIFICATE OF LIABILITY INSURANCE TM F DATE(MMIDDIYYYY) 04/03/2015 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(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 Rapo & ]epsen Financial and Insurance Services 1103 Commonwealth Ave Boston, MA 02213 NGUNTAUT AME: ANDRE SILVA PHONE Es,S08-875-5600 ac, N1:S08-87S-S885 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC k INSURER A: Essex Insurance Company INSURED ECUAUSA CONSTRUCTION INC 1S3 ARLINGTON ST APT 2 FRAMINGHAM, MA 01702 INSURER 8: AMCUARD INSURANCE CO INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: EXPRESS ROOFER REVISION NUMRFR: 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 LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY POLICY EXP MMIDDNM LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIA81LITY CLAIMS -MADE a OCCUR TBA 03/12/2015 03/12/2016 EACH OCCURRENCE $ 1,000,000 ENJED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ S'00 PERSONAL 8 ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN 'L AGGREGATE LIMIT APPLIES PER: X I POLICY 7 JECT LOC JECT PRODUCTS - COMP/OP AGG 5 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS HIRED AUTOS AUTOSWNED Es accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PRO per accident $ $ UMBRELLA UABOCCUR EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEO RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUT OFFICERIMEMBER EXCLUDED? 1 '" I (Mandatory In NH) Ues describe under 86 RIPTION OF OPERATIONS below N I A R2WC623453 I 01/16/2015 01/16/2016 I X TORY LIMITS ER E.L. EACH ACCIDENT $ 11000,00 E.L. DISEASE . EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT$ 1 000, 00 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) CERTIFICATE HOLDER CANCELLATION 11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEI ACCORDANCE WITH THE POLICY PROVISIONS. EXPRESS ROOFER mike(0expressroofer.com 16 JONAS RD WESTFORD, MA 01886 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD v Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-099497 MICHAEL L C0Pj,"R a' ' 16 Jonas Road - tia,' Westford MA 01986 Expiration Commissioner 04/24/2016 �;//c> �arxmcnraea�tl, nj��Ilrllnc/resell Office of Consumer Affairs & Busidess Regulation I*OME IMPROVEMENT CONTRACTOR ''registration: 108126 Type: ,Expiration: 8/13/2016 DBA MICHAEL L. CORTNER-EXPRESS ROOFING Michael Cortner 16 JONAS RD WESTFORD, MA 01886 Undersecretary