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Home My WebLink AboutBuilding Permit #51 - 802 DALE STREET 7/20/2007O, NORTh 1 TOWN OF NORTH ANDOVER APPLICA'TION FOR PLAN EXAMINATION SSACHUst Permit No: I Date Received: Date ISSW&�� IMPORTANT: LOCATION_ PROPERTY OWNER�I icant must com 1'rint e all items on this Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING H 1CTnU1f` n1QT1D1d T VFQ rl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building -i Addition -= Alteration ✓6ne family = Two or more family No. of units: ` Industrial !_--:'Commercial �epair, replacement = Demolition C Assessory Bldg Movin > (relocation) r' Other Others: Foundation only Ur.:!)I,.Klr I IUJN Ur W UKK I U lir, FKt PUMMEL) CY OWNER: Name: Address: Ste; CONTRACTOR Name: S�, Duval LLC Phone: 9- 796 hyo PO Sox 637 Address: No. Reading, MA 01864 Supervisor's Construction License: AA Exp. Date: Hume Improvement License: 10951ele Exp. Date: Ze IRCl-IITEC''T+NGINi'FIZ Name: Phone: Address: No. FEE SCHEDULE: BtiLDING PERMIT. -S10.00 PER $1000.00 OF THE TOTAL ESTI '11,ATED COST BASED ON 5125.111/PER S.F. '7(o�ii Total Project Cost S x1rO FFEIA j Check No.: 4� S—a Receipt No.:��c/, ..- 7 Location AyL 1:24/G. C f - No. S Date O.O MORTM TOWN OF NORTH ANDOVER Certificate of Occupancy . ; . cMusEt Building/Frame Permit Fee $� `a S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 204,E wildingn tt3r TYPE OF SEW ARGE DISPOSAL Public Sewer \'ell I Private (septic tank, etc. Tannin-Vassage-Body Art Swimnling Pools Tobacco Sales - Food PackagingrSales Permanent Dunlpster on Site NOTE: Persons contracting ith unregistered contruciurs du not have access to the guartiq), fund 7y ' W Swriature of Agent/Owner Signature of Contractor Plans Submitted ❑ Plans Waived 11a' Certified Plot Plan 01 Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED _ DATE APPROVED PLANNING & DEVELOPMENT ❑ Il ❑Water Shed Special Permit �J Site Plan Special Permit ❑ Other COMMENTS DATE, REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH f-1 COMMENTS Zonins Board of Appcals: Variance, Petition Zoning Dccision .`receipt submitted yes Plallnim-,' Board Dwsion: Conservation DCCISI(111: �k ater & Sewer conncction signature &- date Corninents Temp Dunlpster on site ycs___no__ Fire Department signature.'date Building Permit ,approved and Issued by: Building Setback (ft.) Front Yard I Side Yard I Rear Yard ReLlUired 'I Provided 1 Required I Provides Required 1 Provided DIMENSION N umber of Stories: Total land area, sq. ft.: Total square feet of floor area. based on Fxterior dimensions. - I d P, 1( IS i;i PI. P. 1: 11 i PI 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 • Debris Removal Form Workers Comp Affidavit :j Photo Copy Of H.I.C. AndiOr C.S.L. Licenses u Copy of Contract u Floor Plan Or Proposed Interior Work Addition Or Decks u Building Permit Application u Form U Li Surveyed Plot Plan u Debris Removal Fonn u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) u Building Permit Application u Form U • Certified Proposed Plot Plan • Photo of H.I.C. And C.S.L. Licenses • Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) zi Copy of Contract Mass check Energy Compliance Report In all cases if a %ariancc 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: I IONAL SERI ICES DEPARTNIENT:RPFOR.NIUS r ................ mn. . 1 10191 fpp_0SA7 aarR• nn9 nR Mi WDfW-, CERTIFICATE OF LIABILITY INSURANCE 0f/20/2 o PRODUCER (781)942-2225 FAX (781)942-2226 Gilbert Insurance Agency, Inc. 137 Main Street Reading, MA 01867-3922 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC N INSURED Duval Roofing, LLC. P.O. Box 637 North Reading, MA 01864 INSURERA: St. Paul Ins. Co. 000890 INSURER B: INSURER C: INSURER D' INSURER E: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR LTR DD' RjSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCYEXPIRATION DATE IMMIDDIM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAtru1' TO RENES �Fa TED r $ CLAIMS MADE [—] OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1 GENERAL AGGREGATE $ GEM'S AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY JE LOC AUTOMOBILE UASILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ee accident) BODILY INJURY I $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE UABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY. AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F7 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 7PJUB-7334880-A-06 03/11/2007 03/11/2008 1 WCSTATT GTH- ER E.L. EACH ACCIDENT $ LOO, OO EMPLOYERS' LIABILTIY A ANY PROPRIETORIPARTNEREXECUTIVE E.L. DISEASE- EA EMPLOYEE $ 100,000 OFFICERIMEM13ER EXCLUDED? If yes. describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT I $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Town of North Andover Town Hall North Andover, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL WOSE NO OBLIGATION OR LIABILRY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 2S (2001/08) FAX: (978)688-9542 OACORD CORPORATION 1988 &/� J UP- Page No. of Page rr Builders License # 58443 Home Construction Reg. # 109288 �o O o 00 a (781) 944-1994 (975) 664-2557 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 PRO OSACSU MITTEDTODATE i `_ l 1r�•69>•�// plc' t��.p�g{�gj� 1 / X CITY, STATEA�J ZIP CODE JOB LOCATION _ `1; 1 (✓t, We hereby submit specifications and estimates for: Recommended Optional tr c I.� wa 1� " t�, r� (Included in price) (Not included in price) /'Rirp T �1 1_. - - -& Remove all shingle debris from roof & job site: ❑ 1 layer 0 2 layers ❑ 3 layers or more Repair/or Replace any roof decking; not to exceed 50sq. ft. Install 8" aluminum drip-edge/and rake -edge along entire perimeter. Choice of mill rhMite�or brown y Install ICE & WATER underlayment along horizontal eaves, valleys, sidewalls and sky -lights & chimneys. Install premium base sheet underlayment between roof deck and roofing shingles • Install 25yr CertainTeed/GAF/Tamko or Owens & Corning traditional 3 -tab roof shingles ❑ 30 year Install 30yr CertainTeed/GAF/Tamko or Owens & Corning architectural roof shingles ❑ 40 year ❑ 50 year LI -Lifetime - -- _ --- -- - - I See manufacturer warranty policy for more details jt r� Install new aluminum vent -pipe flange (s) Chimney (s) -counter-flash and re -step existing flashing ❑ Cut & Install new lead flashing Z/ Ridge-vent/exhaust vent with low profile design, hidden by shingle caps ❑ Soffit -ventilation 4' ❑ Roof louver -vents v • Seamless style aluminum gutters - custom fabricated at job site ❑ downspouts Other �� ,� �, , -_--r�1 �'2%� ` � {__ O !'iLj7lr art !=y.� '-i � L✓ca _1 � .. � 1 '! '_2 - - I 'Please Note: All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear -off Price includes all items above that are checked only / others may be priced separately upon request. j e Praynse hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: Total price not including options. dollars ($ �"- -' r. U ). Payment to be made as follows: 30% deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of $50 per week for all outstanding bills due upon day of Authorized completion. Signature - Accepting proposal means agreeing to the terms of the enclosed binder Note: This proposal may be contract. Please sign contract & return top copy (white) with deposit. withdrawn by us if not accepted within _ days The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ir Boston, MA 02111 www massgov/dia Workers' Compensation ,Insurance davit: Builders/Contractors/Electricians/Plumbers Name (Business/Organizadon/Individual): Address:` No. Reading, €SIA 01864 City/State/Zip: Phone Are V02-9-11 employer? Check the apropriate box: 1. M;'11m a employer with 4. ❑ I am a general contractor and I ---Q-'-' — employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We area corporation and its required.] 3. El am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. C. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Dernolition 9. Q Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. oof repairs 13.❑ Other - -- •- - - •- — — n. -u- arso na out ute section below showing their wodws' compensation policy information. f MomcOwnm who submit this affidavit indicating they are doing all work and titer 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-contraaton 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: Policy # or Self -ins. Lie. #: - 22 3cl MO 40--7- Expiration Job Site Address aLt City/State/Zip: AV Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 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 insurance coverage verification. I do hereby cer16 under the pains and penalties of perjury drat the information provided above is true an¢ correct UJJicial use only. Do not write in this area, to be completed by city or town official. City or Town: PermWLicense # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: m Izia (Location of Kacility) Signature of Permit Applicant Wilde A7 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector \ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 109288 Expiration: 9/9/2008 Type: DBA DUVAL ROOFING Kenneth Duval 72 NORTH ST�� N. READING, MA 01864 Deputy Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid without signature