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Home My WebLink AboutBuilding Permit #418-15 - 92 LISA LANE 10/31/2014 BORT►♦ BUILDING PERMIT • OFA 1. 11 ! OL TOWN OF NORTH ANDOVER ° A APPLICATION FOR PLAN EXAMINATION * - - * : _ b e Date Received Permit NO: ., f AAw TlO 4ssq Date Issued: �� CNUS�� IMPORTANT:Applicant must complete all items on this page LOCATION 1P int PROPERTY OWNER Print MAP NO: y� PARCEL:/� ZONING DISTRICT: Historic District yes/no Machine,Shop Village yeno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building V One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial V Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: w IIA&Crt"q i-Z7 ATLI Phone: - Address: v 92- b S A LA,&j c o A al e- 1$ �/ CONTRACTOR Name: r Phone: l� A l O.A5.ro S 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: $ V50(9,00 FEE: $ A� Check No.: /Jr.23 Receipt No.: c2.oq--PV NOTE: Persons contracting with u A ' te d contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Owl`_� 4 li r BUILDING PERMIT NORrH w- -' O�'(t 'Ep b q-YQ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 4 Permit No#: Date Received �QApRAr �SSACHU`�� 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 ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Rep replacement lacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic' 0 Well ❑floodplain ❑Wetlands El Watershed District ❑Wates/Sewer - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor. Name:_ . __ _ _ -, -:Phone: Address: S.upervisor's'Construction License: ___ _ _a -_ Exp. Date: _ r Home4mprovement License:; r_ = 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: $ • i Check No.: Receipt No.: ti NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of 6-gent/Owner _ Signature of contractor 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 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) ❑ 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 ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract Li 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 nm ust be submitted with the building application Doc:Building Permit Revised 2014 :(y Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming 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 - U FORM r' PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 OsgoodStreet FIRE DEPARTMENT - Temp Dumpster on,site. ,yes __ no Located at 124 Main-Street Fire Department!s_ignatureldate COMMENTS it Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I 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.$1oo-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location q---� �'- /_ No. Date f s - TOWN OF NORTH ANDOVER r Certificate of Occupancy $ ri Building/Frame Permit Fee $/ r - Foundation Permit Fee $ Y Other Permit Fee $ TOTAL $ 4 Check# 23208 Building Inspector v NORTH own ® t _E .,� Andover O No. h ver Mass coc MICHIWICK y1' 4ATIE U' BOARD OF HEALTH PERMIT. Food/Kitchen LD _ _ Septic System trK (eatnewav.... BUILDING INSPECTOR THISCERTIFIES THAT ....................................... ................................... . ........................... has permission to erect .......................... buildings on .....9.X........!. %000 �........•••-• ........ Foundation ft Rough to be occupied as � ......•.••-••••••••••-•-•••••••••••••-• Chimney ........ .. .. .. .............. ........... . .... . ....... provided that the person acceptin this permit shall in every respe 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR i�i • UNLESS CONSTRUC N RTS Rough ........,... Service ........ .. ... ...... ............: ............ 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. i 40 Harvard St. Malden MA 02148 Office 781-480-4558 Cell 617-935-9563 Fax 781-480-4559 D GD M aabroofingpaintina(awahoo.com www.aabroofing.net Tim Cleary 92 Lisa Lane North Andover MA 01845 617-719-4848 PROPOSAL/CONTRACT 10/24/14 Description of Specifications: The work will be performed at above address. • Remove and replace shingle roof over entire house • Install ice and water shield over entire roof • Remove and replace rotted wood where needed • Install 8"white metal drip edges around edges of roof • Install ridge vents • Install ridge caps • Remove and replace pipe boot • Remove and replace exhaust vent • Remove and replace lead flashing around chimney • Install step flashing where needed A.A.B.Roofing& Painting,Inc.will provide: • All material • Disposal • Labor • Cover all plants and other items around house • Magnetize whole house at completion of work Material: • CertainTeed Landmark architectural • Drip edges shingles • Ridge vents • Ice and water shield • Ridge caps • Wood • Pipe boot ti • Exhaust vent • Step flashing • White metal • Nails • Lead flashing 3-4 days to remove old materials, clean and install new materials, subject to weather ALL MATERMLS,LABOR,PERMITAND DISPOSAL PROVIDED BYA.A.B. ROOFING & PAINTING,INC.,LICENSED AND FULL Y INSURED. SHINGLES HA VEA 40-YEAR GUARANTEE. ALL LABOR HASA 10-YEAR GUARANTEE. IFMORE THAN S% OF WOOD NEEDS TO BE REPLACED, THERE WILL BEANADDITIONAL CHARGE OF $150.00 PER 100 SQ. FT. Payment Conditions: Cost: $8,500.00, due day of completion of work ANYAL TERA TIONS OR DEVIATIONS FROM THE ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN,SIGNED AMENDMENT TO THIS PROPOSAL AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE. RESPECTFULLYSUBMITTED BY. A.A.B. ROOFING& PAINTING,INC. ACCEPTANCE OF PROPOSAL THE ABO VE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBYACCEPTED. YOUAREAUTHORIZED TO DO THE SPECIFIED WORK. PAYMENTS WILL BE MADE AS OUTLINED ABOVE. Signature: Date: 10/ ZS b m Cie Signature: Date: ` 0- a Adail Bas0s G� 13D Rig0 1g ��OAJ�'OGbG Oanc_ I AAB 10-24-14 roof Tim Cleary North Andover 2 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Contraction Supervisor Specialty- License:CSSL4728 t ADAAB�RASTOT S�/�� y� w rte•.' 40H1R ARDS MAISIMMA 0249 's ,a %541 Expiration CamadE loner t1T/31i2Q'!S Cie tpamvina�r�irea o�Vl�alsacuaeL License or registration valid for individui useonly Office of Consumer Affairs&Business Regulation f found return to- beforethe expiration date. I - OME IMPROVEMENT CONTRACTOR_ Office of Consumer Affairs and Business Regulation eg,stration: ';'153205 Tom' 10 Park Plaza-Suite 5170 Wftpoiratlon,--�L4t2f11fr Private Corporation Boston,MA 02116 AAB_ROOFING&'PAINtING--= 40 HARVARD ST i9on 11 risb iJ � MALDEN,MA 02148 Undersecretary Not valid without signature ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 10/16/2014 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(tes)must be endorsed. If SUBROGATION IS WANED,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 CONTACT NAME: Rapo & 7epsen Financial and Insurance Services PHONE617.783.1160 x,617.783.2062 1103 Commonwealth Ave ADDRESS: Boston, MA 02215 WSURER(S)APFORDIMG C OVERAGE MAIC 0 INSURERA: Penn-America Insurance Company 1NsuRED AAB ROOFING AND PAINTING INC INSURERS: Arbella Mutual Insurance Co. 17000 40 HARVARD STREET INSURERC: BERKSHIRE HATHAWAY GUARD INSUR MALDEN, MA 02148 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:10/16 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 POLICY EFF POLICY ExF LTR TYPE OF INSURANCE QJSR v POLICY NUMBER (MWDDA*YM JMMIDDIYYM LIMITS GENERAL LIABILITY PAC70S27S4 08/08/2014 08M2015 EACH OCCURRENCE $ 1,000,0001 X COMMERCIAL GENERAL LIABILITYPREMISES m:aarertce) $ 100,OO CLAILAS MADE OCCUR MED EXP(Aly one person) $ S'00 A PERSONAL&ADVINJURY $ 11000,00 GENERAL AGGREGATE It 2,000,00 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,00 X POLICY �C LOC s AUTOMOBILE LIABILITY 10200063S4 08/31/2014 08/31/2015 aoaaern) $ ANY AUTO BODILY INJURY(Per persmi) $ S0,000 ALL OWNED SCHEDULED B AUTOS X AUTOS BODILY INJURY(Per a=derd) $ 100,000 N-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS S (Per accident $ 100,00 $ UMBRELLA L" OCCUR EACH OCCURRENCE $ EXCESS LIAR C DE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION R2WCS07196 08/19/2014 08/1912015 X AND EMPLOYERS'LIABILITY YIN TORY LIMITS I I ER C oFFtcROER�Ie°ER EXC W'UT� NIA E L EACH nccmENr $ 100,000 (Mandatory in NH) EL DISEASE-EA EMPLOY $ SOO,0O if yes, wxW DESCRIPTION OF OPERATIONS betomEL DISEASE-POLICY LMIIT $ 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarlm Schedule,K more space Is tegWreM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BERM THE EXPIRATION DATE THEREOF,NOTICE WILL.BE DELIVERED 91 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 70HN RAPO 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents Ojfwe of Investigations 1 Congress Street, Suite 100 t Boston,MA 02114-2017 ° 5••'� www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibly Name(Business/Organization/Individual): a°`B Roofing & Painting, Inc. Address:40 Harvard St. City/State/Zip:Malden MA 02148 Phone#:617-935-9563 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 3 1 4. ❑ I am a general contractor and 1 employees(full and/or part-time). : have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' g ❑Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insuranceuired t c. 152,§1(4),and we have no ] 13.[:]Other employees..[No workers' comp.insurance required] 'Any applicant that checks box#I 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. iContractors 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. Insurance Company Name:Berkshire Hathaway Guard Insurance Companies Policy#or Self-ins.Lie.#:R2WC507186 Expiration Date:8/19/15 Job Site Address: 11 ] S City/State/Zip:(V�J(��1�AA1Q0d1hA MR 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 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 insurance coverage verification. er'u that the information provided above is true and correct I do herebycertify under the airs and penalties<of p � ry f p fY P ,y- I Signature: �7Date: Phone#: 617-9359563 Official use only. Do not write in tl:is area,to he completed by city or town oJj` al 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 i 6.Other Contact Person: Phone#: