HomeMy WebLinkAboutBuilding Permit #397-14 - 594 CHICKERING ROAD 10/24/2013 f NORTy q
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BUILDING PERMIT
TOWN OF NORTH ANDOVER °
PPLICATION FOR PLAN EXAMINATION ;
Permit NO: Date Received ' °4
Date Issued: % Z- f� SSACHUSE
IM/PORTANT:Applicant must complete all items on this page
LOCATION �%7 1z'h)G/(91EiA)4 ,
Pnnt
PROPERTY OWNER J�I��i1Z, C�
n�
Print
MAP NO: D76 PARCELED • 7 ZONING DISTRICT: Historic District yesno ,
Machine Shop Village yes(no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alter 'on No. of units: mmercial
V,Ke'pair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District
❑ Water/Sewer
Identification Please Type or Print Clearly)
OWNER: Name: 641W&
(ft4 Phone: 9 7P-10
Address: 041 014ic ele),g dZ4 luo ifn4zg�
CONTRACTOR Name: Phone:
Address:
n! ZZ Rd .34,5 7-02V , 1D,-01 O Z,13,g,1
Supervisor's Construction License: Exp. Date:
Cs ��� �L� ii,/� ��_3
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER AloW E Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED�ST B SED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.:—,- Receipt No.:
NOTE: Persons c ratting with unregistered contractors do not have ac t aranty fund
Signature of Agent/Owner Signature of contrac r
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO; Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: 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 ❑ Floodplain ❑Wetlands 0 Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: Phone:
Address:
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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Plans Submitted E Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Location leee-Ac
No. _ Date 0
3I If
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $� .—
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
uilding Inspector
Plans Submitted ❑ Plans Waived ❑ -Certified Plot Plan ❑ Stamped Plans ❑
TYPE_OF-SEWERAGEDiSP_OSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑. . Swimming Pools ❑ s
Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc..- ❑-. , .permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
.DATE REJECTED DATE.APPROVED
PLANNING & DEVELOPMENT- ❑ ❑
COMMENTS
.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
Conservation Decision: Comments
Wafer & Sewer Connection/Signature& Date Driveway Permit
DPW Toiv;2 Engineer: Signature:
a
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located'at 124 Mair Street
Fire Departinerit signature/date-
COMMENTS
Dimensifln -
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
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Ll Notified for pickup - Date
I €
Doe.Building Permit Revised 2010
` Building Department
_.. The fol'!owing is---a list of the required forms to be filled out-for the appropriate.permit to.be obtained.
Roofil-,,g, 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/Crossection/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
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
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ 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 apo%-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doe.Buiiding Permit Revised 2012
Rightfax N2-2 10/28/2013 5:57:04 AM PAGE 2/002 Fax Server
CERTIFICATE OF LIABILITY INSURANCE D 1 012/1901 1 YI
FlCATE 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.
IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE
OR PRODUCER.
IMPORTANT:It the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the
arms and conditions of the policy,certain policies may require and endorsement A statement an this certificate does not confer rights to the
certificate holder in lieu of such endorsemen s.
PRODUCER CONTACT
NAME:
AXTAINS SVCS INC PHONE FAX
933 EAST COLUMBUS AVE (A/C,No,Ext): (A(C,No):
E-MAIL
SPRINGFIELD,MA 01103 ADDRESS:
765DP INSURERS)AFFORDING COVERAGE MAIC#
INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
S G MCNALLY LLC INSURER B:
INSURER C:
INSURER D:
12 FORBES STREET
INSURER E:
JAMAICA PLAIN,MA 02130 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
IHISISTULIMII" MURANCE LISTED BELOW HALVE BEEN ISWEDTO 7M MREDMMEDABOVE FOR TWFMMRF1O0 INDICATM NDTVWT�-WANDW
MYREOJRBVM,TERM ORCONCITICNOFANY CCNTRACPOROIHERDOCLIME IT1MiHAESPELTTOMCHTHISCER11FICdTEMAYBEOWEDORMAYPERTEWt 1HEINSUPANCE
WORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL 7HE TMffik EI(CLUSIONS AND CONDMONS OF SUCH POLIO ES.LIM1 SSHO MMAYHAVEB1E FaUCEDBY
PAID CLAIMS
NSR ADD SUB POUCY EFF[TATE POLICY EXP DATE
LTR TYPE OFMRANCE L R PCUCYNUMBER (M*DDYYYY) (NADD\YYYY) LIMIM
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $
CLAIMS MADE EJ OCCUR. 3REMISES(Ea occurrence)
P� [ERSONAL
EXP(Any one person) $
&ADV INJURY $
GENL AGGREGATE LIMIT APPLIES PER: ERAL AGGREGATEPOLICY 1:1PROJECT❑LOC DUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALLOWNEDAUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION$ $
A WORKER'S COMPENSATION ANDvc STATUTORY an-ER
EMPLOYERS LIABILITY YIN UB-58867263-13 03/12/2013 03/12/2014 X UMTTS
ANY PR7PERTOBPPRTNERS(ECU IVE WA E.L EACH ACCIDENT $ 500,000
OFRCERMEJBER EXCLUDED?
(MavftoryinNH) E.LDISEASE-EAEMPLOYEE $ 500,000
r,descri6B fader
aoPTicNOFOPEPAl1ombd. E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VENICLESIRE$TRICTIONSJSPECiAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER BUILDING DEPARTMENT SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED
16(}0 OSGOOD STREET
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENT4VVE
NORTH ANDOVER,MA 01845
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATIOK AI I rights reserved
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information // PIease Print Legibly
Name (Business/Organization/Individual): cam- n_y__AJ L-4, C—,
Address: Mal (a
City/State/Zip: oz-( 3e) Phone#: (o t-7 5-2-2---5-353
Are,yo n employer?Check the appropriate box: Type of project(required):
1.Lam!am a employer with 5,10 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or p -time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. E]Building addition
[No workers'comp.insurance 5. F1 We are a corporation and its 10.E]Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12. repairs
insurance required.] employees.[No workers'
comp.insurance required.] 13.[:]Other
*Any applicant that checks box 41 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 their workers'comp.policy information.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: VA Le-4 C 1/6-SBE-67Z(0 3 -13
Policy#or Self-ins.Lic.#: Expiration Date: 3 1/2-
Job Site Address: City/State/Zip: .�f
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for' ance coverage verification.
I do hereby certify uncle pa' and pe altiesrjury that the information provided above is true and correct.
Simature: Date:
Phone#:
Official use only. Do not write in this area,to b 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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or.written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced-acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Musachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel,#617-727_4900 oyt 406 or 1-87�MASSAFB
Revised 5-26-05 Fax#617-727-7749
wWVVMass.goV as
nisnT.xax ni—J. u/"LU/GV13 '/:;3'l:4J AM PAUL •L/Uvz P'ax Server
' CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDDlYYY1f1
FICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE ODE .
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
P ESENTATIIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT.Itthe cerifficate holder is an ADDITIONAL INSURED,the pollcWes)must be endorsed. If SUBROGATION IS WAIVED,subject to
e terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to
e certificate holder in lieu of such endorsemen s.
PRODUCER CONTACT
NAME:
AJQA INSURANCE INC PHONE FAX
933 EAST COLUMBUS AVE (A)C,No,Ext); (AIC,No):
IE-MAIL
SPRINGFIELD,MA 01103 ADDRESS:
765DP INSURERS)AFFORDING COVERAGE MAIC Y
INSURED INSURER A. TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
S G MCNALLY LLC INSURER B:
INSURER C:
INSURER D:
12 FORBES STREET
IN E:
JAMAICA PLAIN,MA 01230 INSURER F.
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
HAVE BEEN WO TO THE INiOREO BMW A VE FOR THE PGUCY PERIOD MOVED.
NOTWITHSTANDING ANY REQUIREMENT.TERM OR CON0910H OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN.THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POUCIES,LBfT8 SHOWN MAY
NAVE BEEN REDUCED BY PAD CLAM.
INSR ADD SUB POLICY EFF DATE POUCY EXP DATE
MMt
LTR TYPE OF INSURANCE L R POLICY NUMBER ( DMYYYY) (MKWIMYYYY) LIMITS
GENERAL LIABILITY --ACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $
CLAIMS MADE ❑OCCUR. REMISES(Ea occurrence)
[RD P(Any one person) $
GEN'L AGGREGATE LIMIT APPLIES PER NAL 8 ADV INJURY $
AL AGGREGATE $
POLICY PROJECT[:]LOC CTS•COMPIOP AGGAUTOMOBILE LIABILITY NED SINGLEANYAUTO Ea accident)
ALL OWNED AUTOS INJURYSCHEDULEAUTOS rson)HIRED AUTOS INJURYNON-OWNED AUTOS ddent)
RTYDAMAGE $
ident)
UMBRELLA LIAB r7 OCCUR EACH OCCURRENCE $
EXCESS LIAR rn CLAIMS.MADE AGGREGATE $
DEDUCTIBLE $
RETENTION S $
A WORKER'S COMPENSATION AND XWC STATUTORY OTHER
EMPLOYER'S LIABILITY YIN US-58887283-13 03M212013 0311212014 LIMITS
ANY PROPERITOR.PARTNERIEXECUTIVE NIA E.L.EACH ACCIDENT
CFROERMEMB $ SQO,000
ER EXCLUDED?
(MuddOryin" EL DISEASE•EA EMPLOYEE $ 500,000
Ityes,desoribe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POl.IGY LIMIT $ 500,000
DESCRIPTION OF OPERATIONSILOCATIONSIVEH)CLESItESTRICTIONSISPECIAL I7EM
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE.SOLDER ABFECTWO WORKERS COMP COVHRAOB.
CERTIFICATE HOLDER CANCELLATION
WINDOVBR CONSTRUCTION INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
13 ELM STREET BEFORE THE EXPIRATION DATE THER80F,NOTICE WILL,BE DELIVERED
INACCORDANCE WITH THEPOUCY PROVISIONS,
MANCHESTER,MA 01944
AUTHORIZED REPRESENT
25(2010145)ACOMIhe ACORD name and logo are reg erect marki of*00 ISM2010 ACORD CORPORATION. All rights reserved.
NORT1i
Town of 1 E .., ndover
O - . �
No. * -
,� ah , ver, Mass, f
COC NIC Nl wICN �1'
AERATED I �2
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ......... NJ Ca e ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR
C .. Foundation
has permission to erect.......................... buildings on .3%�... .. ...... .... ... �..........
Rough
to be occupied as ...........�.�en'?,.I'Ql ......... .. .4�. .... ..®......................................... Chimney
provided that the person accepting this permit shall in every res pe onform 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`
�I -PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
�D UNLESS CONSTRUCT 10aT Rough
Seryice
................ .................................................... 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.
SEE REVERSE SIDE
f.
Massachusetts-Department of Public Safety + i
Board of Building Rdqulations and Standards
Construction Supen'isor
License: DSS-044326
STEPHEN G M&ALLY"
198 MT VERNON 5T �}
W ROXBI MAa 02132 1
Expiration
Commissioner 11/06/2013 y
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Sept 10, 2013
Submitted To: Job Location:
Facilities Services Group LLC Kinder Care
317 Oakton Ave. 594 Chickering Road
Pewaukee, WI 53072 No. Andover, MA
ISR 0 PO SA L
DESCRIPTION OF WORK: INSTALL NEW TPO MEMBRANE ROOF SYSTEM
Work to be performed at 594 Chickering Rd., in No. Andover, MA, for All American Roofing LLC,
by S G McNally LLC (DBA McNally Roofing Co.) as described on page 2 of this proposal. All
work shall be done to Industry Standards and according to the manufacturer's specifications.
Any work will be done under written change orders and be paid upon completion of the
work for that change order.
Commonwealth of Massachusetts Construction Supervisors License#044326
Commonwealth of Massachusetts Home Improvement Contractor Reg #160513
We are a member of the Northeast Roofing Contractors Association, National Roofing
Contractors Association and the Better Business Bureau.
We hereby propose to furnish all labor and materials—complete, in accordance with the above specifications,for the sum
of Thirty eight thousand ..................dollars. ( $ 38,000.00)'` with payment to be as follows:
PAYMENT 1 —$14,000.00 Upon completion of gravel removal and delivery of materials.
PAYMENT 2 —$24,000.00 Upon completion of work as described herein.
This proposal is subject to acceptance by Sept. 31,2013
STEPHEN MCNALLY
Authorized Signature
ACCEPTANCE OF PROPOSAL
All material is guaranteed to be as speed.All work to be in a workmanlike manner according to stand practices.Any
alteration or deviation�fromlxw-sl�lca i extra costs, will be executed only upon written orders, and will
become an extra chand ab is contra 11 agreements contingent upon strikes, accidents or delays
beyond our con Gen, r and work ompensation insurance will be provide for duration of job.
Q
Signature. DATE: 0 j
GaGCJ0Z7D� )ToGOO
Commercial Roofing
Sept. 10, 2013 Page 2
Submitted To: Job Location:
Facilities Services Group LLC Kinder Care
317 Oakton Ave. 594 Chickering Road
Pewaukee, WI 53072 No. Andover, MA
Thank you for the opportunity to bid on your new roof, we propose to furnish materials, labor and
equipment needed to successfully complete the following:
INSTALL NEW TPO ROOF SYSTEM
1. Building permits are included in this proposal. We will provide crane service to reach
the roof from the parking lot. Accommodations need to be made for trucks in the lot.
2. Provide vacuum services to remove and dispose of the roof ballast.
3. Remove the existing rubber membrane and dispose of.
4. Keep the existing perimeter metal.
5. Inspect wood blocking around the perimeter for damage or rot. Any damaged wood
blocking is at an additional cost.
6. Mechanically attach the existing roof insulation using Olympic Lite Deck fasteners and
3" insulation plates.
7. Mechanically attach .060 white TPO Roof Membrane by Johns Manville.
8. The perimeter will have 2 half sheets installed and the remaining field of roof will
receive full 10'wide sheets.
9. Field seams will be heat welded with a robotic hot air welder.
10. The membrane will run over the roof edge for termination by the perimeter metal.
11. Flash curbs and penetrations as per manufacturers specifications.
12. Perimeter metal will consist of custom fabricated .032 white aluminum gravel stop with
a 3 1/2"face. Larger metal can be installed at an additional cost.
13. Remove and dispose of all generated trash from the site.
14. Roof system is being installed according to Johns Manville Fifteen (15)Year Full
System Warranty specifications. Warranty if any is by others.
ALL FOR THE SUM OF $ 38,000.00
71(,117)11522-5353
12 Rock Hill Rd. o P O Box 300612 o Boston, MA 02130 o o Fax(617) 522-5385