HomeMy WebLinkAboutMiscellaneous - 87 FARRWOOD AVENUE 4/30/2018Date......... ...........
I)l . .. ...... ..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
................... j ....................................... ...... ........................
has permission to perform YJ'4- VV C.J C
'�l .. ! .................................................................................................
wiring in the building of
at ..... ....... . . Njrth Andover, Mass.
Fee ................... . ......... Lic. No)Ab
. .. ....................... 6.
-,Check R ............ ELECTRICAL
rI f I
,-�AudL
P� L&v,- d- e e- ,
�nwe�ItFi �f 64 s s a c h u s e t t s
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use my
Permit No.
Occupancy and Fee Checked
[Rev. 1/07] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 4 LAADo i /q%J1i
Owner or Tenant C11JJ:✓ Telephone No.
Owner's Address LAIN , + 3— AJ ffA 4 f)
Is this permit in conjunction with a,building permit? Yes P No ❑ (Check Appropriat Box)
Purpose of Building Utility Authorization No.
Existing Service � 92 AlWo/
ps �/ lts Overhead Undgrd ❑ No. of Meters
New Service T ArAs fr tJ Volts Overhead ❑ Undgrd ❑ No. of Meters_. --
Number of Feeders and Ampacit f
Location and Nature of Proposed Electrical Work:
Completion letion of the followin table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans ��
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA'�
No. of Luminaires ,
Swimming Pool Above ❑In- ❑
nd. rnd.
o. o mergency mg
Batter Units
No. of Receptacle Outlets %
No. of Oil Burners
FIRE ALA S
No. of Zones
No. of Switches
No. of Gas Burners,No.
o etection and
nitiatin Devices
No. of Ranges
Ngo. of Air Cond. Ton's
1(. of Alerting Devices
No. of Waste Disposers
Heat Pump
I Num.. er I
Tons
..................
KW
......................
No. o Self-Containe %
Totals:
x,
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating'KW
Local ❑ Municig, al ❑ Other
Cyyonne6tion
No. of Dryers /
Heating Applia ces KW
Sectio. ofAevices * Equivalent
No. of WaterNo.
KW
o No. o
Data Wiring:
Heaters
$i ns Ballasts
o: of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
T ecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electri al Wor : Z�` (When required by municipal policy.)
Work to Start: % Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cover a is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
1. certify, under the pai nd penaltie perjury, that the inf mation on this a ation is true and complete.
FIRM NAME: \ 6 LIC. NO.: Z�6
Licensee:
41— Signatu
_ LIC. NO.: 011�
(If applicable, ente "ea ��n f: �n th_e license n lin�'}� Bus. Tel. No.: -
Address: r C� SCJ It. Tel. No.:
*Per M.G.L c. r47,s. 57-61, security work requires Department of Pub is Safety "S" Lice Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ /
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Date. .5-11 .
NORTH TOWN OF NORTH ANDOVER
o PERMIT FOR PLUMBING
Y ,SSACMUSEt
This certifies that ..�' !. ..�Y .( ....................
has permission to perform ....H. .L.-'�- ........................ .
plumbing in the buildings of .../!"f.!°'.'. {.7 ................. .
at..... .).�. �.!... t ��.�.. !.... . ......, North Andover, Mass.
Fee. U.... Lic. No.. a1 GI y.. ........ f .... V`'),a....... .
PLUMBING INSPECTOR
Check # /C Y7 Y
0610
A*
Y
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or Pte)
NORTH ANDOVER, MASSACHUSETTS
Building
.. , y AiNSM
—Y7 Pvyoa j
New (3 - . Renovation ❑
Date
Permit # (l o
Amount
Replacement * Plans Submitted -Yes ❑ . No
vnnt or 4`Pe) ) n , .
Installing Name In D lT' 1 �'C`� ii' Check one: Certificate
Address 1� L 6 t3
n'► eg 7,6 ❑Partner.
Business Telephone j— B
[.9—Firm/Co.
Name of Licensed Plumber A it 4A
Insurance Co m— Indicate the type of insurance coverage by checkI,tabrhty insurance Policy Other type of indemnity ❑ boic
Bond ❑
threeinsurance Waiver the have been made aware
three that the Iicxnsee of this application does not have any one of the above
th
Signalum Owner Agent E]
I hereby certify that all of the details and iafmmation I have submitted (or entered) in a
best of my knowledge and that all plumbing work tions tion are true and accurate to the
lication will
compliance with all pertinent provisions of the Mas State P 1 of thethisaGeneral Laws. be in
�a o kens
Title Type of Plumbing Li
City/Town 1 c n e um �r
APPROVED tomm vsE ora.Y Master Jo"meyman ❑
10
Date... ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .....
has permission for gas installation .... ...............
in the buildings of ... A ........................
at T' .
?q.A P. .'� ....... I North Andover, Mass.
Fee ... .... Lic. No...
GASINSPECTOR
Check #
7217
f
MASSACHusuTS umoRMAPPUCATON FORPU MTT TO DO GAS FITTING
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations iz W -V O d
rermit # Tv
Owner's Name
New ❑ Renovation 1:1 Replacement B
1� (amount $
IdiPlans Submitted ❑
y �
Li
z
C y�
SUB -BASEM ENT
BASEMENT +
v 1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
STH. F D0R
(tet or type
Nav
metP
Address —rQ_ VS p D( 6 6 5—
�`- *,4m P 3�b
'f elephone
Name of Licensed Plumber or Gas Fitter 7) A7 ri , i\ 7 1
eck one: Certificate Installing Company
Corp.
Partner.
0-Firm/Co-
INSURANCE
'Fi m/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. YesET--
No❑
If you have checked please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑ Other type of indemnityBond
❑ ❑.
Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
.... Check one:
Signature of Owner or Owner's Agent Owner ❑ A
I hereby certify that all of the details and information I have submitted (or entered) in above
best of my knowledge and that all plumbing work and nsetts
ons perfo ed under Permit i
compliance with all pertinent provisions of the Ma sac
tateG�d"d Chi 1
Title
City/Town
(APPROVED (OFFrCE USE ONLY)
Signature of Li
Plumber
❑ Gas Fitter.
Master
inJourneyman
ged Plumber Or Gas Fitter
99�y
icense Number
n are true and accurate to the
this application will be in
General Laws. .
p I �V(" 5 w
Ocinb awe t �.
TOWN OF NORTH ANDOVER BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
y �' Section for Official Use Only
BUILDING PERNfIT NUMBER: r DATE ISSUED:
SIGNATURE:
Buildi2& Commissioner/I or of Buildings Date
1.1 Property Address:
1.2 Assessors Map and Parcel Number.3
�
�s7 Fc�Yrwao 1 lav
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Areas Frontage ft
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required
Provide —Required
Provided
R red
Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zona ❑Municipal
On Site Disposal System ❑
rai y U wi U. IJr IUL. 0 11411
VAR hi
2.1 Owner offRecord
el1Yll
N (Print) Address for Service :
tV Telephone
2. Authorized Ag
N e t Address forService:
ature Telephone
3.1 Licensed Construction Supervisor Not Applicable ❑
e RA- i l�e��c� , fi'V�iR 4��9
Address License umbar
L' sed struction Supervisor.
Expiration Date
-3J'y
Signature Aclephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Z:C-0X:_-
12 7� � 3
Company Name
Registration Number
' e-' e W
Exprraoon Date
�� S,�
'
Signature Telephone
0
M
Z
0
Z
M
IWorkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the
issuance of the building permit. /
Signed affidavit Attached Yea ....... V No ....... ❑
5.1 Registered Architect:
Address
Signature
Telephone
Company Name:
Kesponsible in Charge of Construction
l—
Not Applicable ❑
C t I �I S
Area of Responsibility
Registration Number
Expiration Date
Name:
Address:
Signature � Total
Not applicable ❑
Registration Number
Expiration Date
Name:
Address
Signature Telephone
Area of Responsibility
Registration Number
Expiration Date
Name
Address
Signature Telephone
Area of Responsibility
Registration Number
Expiration Date
Name
Address
Signature Telephone
Company Name:
Kesponsible in Charge of Construction
l—
Not Applicable ❑
New Construction ❑ Existing Building ❑
Repair(s)
TAlterations(s) ❑
Addition ❑
Accessory Bldg. 0 Demolition 0
Other ❑ Specify
Brief Description of Proposed Work: _1
-1-1PN--� U 0. o t j� l ` �-1 V� C c �' C' �S cz k -CL r'e. p l C- 2.1 Joe- Y-
-�pi�1� P �P—V k Q V- C e G �-- U \r q ` C.7 VO Let
A Assembly ❑ A-1 0 A-2 ❑ A-3 ❑
A4 ❑ A-5 0
�X
USE GROUP Check as applicable)
CONSTRUCTION
TYPE
A Assembly ❑ A-1 0 A-2 ❑ A-3 ❑
A4 ❑ A-5 0
IA
1 B
❑
❑
B Business ❑
2A
2B
2C
❑
0
❑
C Educational 0
F Factory ❑ F-1 ❑ F-2 0
H High Hazard ❑
3A
3B
❑
0.
IInstitutional ❑ I-1 0 I-2 ❑ I-3 ❑
M Mercantile ❑
4
0
R residential V R-1 0 R-2 0 R-3 0
5A
5B
❑
❑
S Storage ❑ S-1 ❑ S-2 0
U Utility ❑
M Mixed Use ❑
S Special Use 0
Specify:
Specify:
Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,
ADDITIONS AND OR CHANGE IN USE
Existing Use Group:
Existing Hazard Index 780 CMR 34:
Proposed Use Group:
Proposed Hazard Index 780 CMR 34:
BUILDING AREA
EXISTING if applicable)
PROPOSED
Number of Floors or Stories Include
Basement levels
Floor Area per Floor s
Total Area s
Total Height ft
Independent Structural Engineering Structural Peer Review Required Yes ❑ No
❑
SECTION 10a Owner Authorization - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property
Hereby authorize to act on
My behalf, in all matters relative two work authorized by this building permit application
Signature of Owner
Date
x�
t
LO as Owner/Authorized
Aged V
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Si under the pains andpenalties of perjury
aWa
Pri N e
Si ture of Own gent ate
-'x0 u
Item
Estimated Cost (Dollars) to be
Completed by permit applicant
1. Building
� _
(a) Building Permit Fee
noo. o 0
Multi lien
2 Electrical
(b) Estimated Total Cost of
G
Construction from 6)
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
Q
5 Fire Protection
6 Total (1+2+3+4+5)
X
Check Number
�tj1J ,�t40.''x' 1I X.dJt''tM-1 �+•'«U�k'' qF - C }/?L Y tt �+:- Y Y '�Si7 _r1.•, if 1^t 71 , 1i }..
(l isR't7 hp J4 ti 1 44 �Ji if'4 4k� F, x�2 ..if 'lti"A6 i.. .iav}Y r,/ FI-. 4 r' ;tit{�t4 ?5Df P ^.:I11 �t.hJ•'.,J:t.
�'S �{��tf51� '.✓1.
's� `T�:.s,s'. %. - \, h•'l }7 -,. .� �Y�i��W. 5'.,•ty'.. rJ [�yh4 ..�'i� f '4.�fit0 !?k�S � 1 \. ,.,:fir {! y„�y it. . } '��"p (t'}u',IiL ��"/,��lt..y. i 'i ht ,�l\ Y.�V � k1:
.S. "Y� Pf„, �P �` l�. b .t � .{.•. S:Y�%G 'o Vr b� ? CV„ t{'. lY' �'1{M}T.@3 '(.Y{JSYi. ��; \'
NO.OF STORIES SIZE '
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2 ND RD
3
SPAN
DEMENSIONS OF SILLS
DEMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
-
zlzz
J & C CONTRACTORS, INC.
85 RIVEREDGE RD. PH. 978-667-8014
BILLERICA, MA 01862
DATE elf
PAY
TO THE
ORDER OF $
DOW
EfPRISE
77117 BANK AND TRUST COMPANY
Y Member Ft' TH RI RICA, MASI 111111"S
FOR 0 — ?&
<
11100S90S11' i:01L302742i: 850 146964711'
Gr ('e e"I cv)N)o .,,it rif J
i b
Location s 4:� —1 4- 7" Ave
No. Date
TOWN OF NORTH ANDOVER
W
Certificate of Occupancy $
C 14U Building/Frame Permit Fee $ 1, 1� (A)
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
FROM NEVE-MORIN GROUP (WED)SEP 14 2005 16:35/ST,16:35/No,6802445832 P i
447 Old Boston Road, ToQt%W, MA 01983, 978-074LW The Neve -Morin
Group, Inc.
RECEIVED
14 200 c>�J
SEP 5
NORTH ANDOVER
CONSERVATION COMMISSION
7b: Pam Merrill Fh= Greg Hochmuth
Few 9784188.9542 Pop": 2
Plane 9784884630 Daft 9114105
Rye 14 & 16 EdgeWm Avenue (Heritage cC: Rosen Ciddo
Green Condornirium)
O urvad X Pw R.w.M► Q w...• 'Pe ewe+.eeI la Presse Reply O P100150 R.e:Ycro
• Pam I was asked to go out to the above referenced address to see if there were
any wetlands within 100 feet of the proposed balcony structure shown on the
attached sketch plan. When 1 inspected the site I did find wetlands in the right rear
corner of the property associated with an Inbemnitbent Stream that flows in a westerly
direction from Route 125. After our survey crew located the wetland flags we put
together the attached sketch. As you can see the proposed balcony structure is
outside of all iudsdictional areas of the North Andover Wetland aw an a awe
We have informed our clients that we would be sending you this fax. N you should
have any questions regarding this infomnation please do not hesitate to contact our
office. I would be mare than happy to meet you on site if you require a site visit.
Greg Hochmuth ow)OWD (omit
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
***********""" ""APPLICANT FILLS OUT THIS SECTION �*
APPLICANT
LOCATION: Assessor's Map Number
SUBDIVISION
STREET 3 of Fa r ✓cy o,:) A A V e— -
OFFICIAL USE ONLY
ENTS:
ATIO"DMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
S
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
PHONE lv `� 4
PARCEL
LOT (S)
ST. NUMBER
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
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
at: - 9,1 — e_is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
of Facility)
Fire Department Sign off:
Dumpster Permit
Signature of Permit Applicant
Date
BOARD OF BUILDING REGULATIONS
4 License: CONSTRUCTION SUPERVISOR
y
s Number: CS 072629
Birthdate: 05/03/1954
Expires: 05/03/2006 Tr. no: 22998
Restricted: 00
ROBERT G INGS
85 RIVEREDGE RD
N BILLERICA, MA 01862 Acting C` mis oner
✓iie C�oorvnw�zureai o/./vGaaoar�u�aetia
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 127563 I
i. Expiration: 11/16/2006
Type: Private Corporation
J & C CONTRACTORS INC
ROBERT INGS
85 RIVEREDGE RD� . -u✓
BILLERIC/k MA 01862 Administrator
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
Associated Employers Irtsur ince Company
Bu rl;n tosn Massachuetts
ITEM
1. The Insured J & C Contractors Inc
Mailing Address: 85 Riveredge Road
9 '' NCCI NO 40959
(800) 876-2765
Billerica
POLICY NO. I WCC 5003615012004
PRIOR NO. I WCC 5003615012003
MA 01862
(No. Street Town or City County State Zip Code
❑ Individual ❑ Partnership ® Corporation ❑ Other FEIN 04-3014138
Other workplaces not shown above:
2. The policy period is from10/03/2004 to 10/03/2005 12:01 a.m. standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here;
MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident
Bodily Injury byDisease $ 500,000 policylimit
Bodily Injury byDisease $ 500,000 eachemployee
C. Other States Insurance: See Endorsement WC 20 03 06 A
D. This policy includes these endorsements and schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rales and Rating plans.
All information required below is subject to verification and change by audit.
Classifications Premium Basis Rates
GOV
CLASS
10042
Estimated
Per $100
Estimated
Code
Total Annual
of
Annual
No.
Remuneration
Remuneration
Premium
INTRA 254745
SEE EXT
NSION OF INFORI
4ATION PAGE
Minimum premium $ 48b.UU t utdi EbumdrVu nnrrunr rran nun. W
As indicated, interim adjustments of premium shall be made: Deposit Premium $ 984.00
® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly
MA Assessment Chg.
$676.00 x 4.9000% $33.00
This policy, including all endorsements, is hereby countersigned by 08/17/2004
IV Authorized Signature Date
GOV
STATE
GOV
CLASS
10042
I KIND
I AUDIT
PLACING
I OFFICE
CLAIM
OFFICE
I NAME
CHECK
SAFETY
GROUP
MA
17
1505
WC 00 00 01 A (11-88)
Includes copyrighted material of the National Council on Compensation Insurance.
used with its permission.
Malcolm & Parsons Insurance
Agency Inc
6 Freeman Street - P O Box 527
Stoughton, MA 02072
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
WWW.massgov/die
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers
Aanlicant Information Please Print Leelbly
Name(Business/organizationnmividual): ---1 °k- °
Address:
City/State/Zip:
�-- Phone #:
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employee's (full and/or part-time)."
have hired the sub -contractors
2. ❑ 1 am a sole proprietor or partner-
listed on the attached sheet t
ship and have no employees
These sub -contractors have
working for me in any capacity.
insurance
workers' comp. insurance.
5. ❑ We are a corporation its
(No workers' comp.
and
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
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
s. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11 -[3 Phhmbing repairs or additions
12.❑ Roof repairs
13.❑ Other
'Any applicant that cheats box 91 must also M1 out the .action below showing thew workers' oompeosation Policy information;
t Homeowners who submit this aiiidevit indicating they are doing all work 11111 then hire outside contractor must submit a new affdsvit indicating such.
tcontrwwa that check this box mast attached sec additional sheet showing dw name of dw wb•oontractors sod thew workers' corm. policy infor mation-
I an an employer that is providing workers' compensation insurEnce for mry enhployeea Below k tot policy and job SIM
information.
Insurance Company Name:
Policy # or Self -ins. Lie. M Expiration Date:
Job Site Address: City/Statozip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiref 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-yearhprisonment, 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 certify under the pales and penakies of perjury that the information provided above b true and correct
Phone #:
Offlchd use only. Do not write In thk area, to be completed by city or town ofj?ciaL
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CityiTown Clerk 4. Electrical inspector S. Plumbing Inspector
6. Other
Contact Person: Phone #:
lniormation alio i113tl u06iiv110
Massacbusetts General Laws chapter 152 requires all employers to provide workers' compew'26611 fot their employees.
Pursuant too 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 employe, 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 apartmen s 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 Shan 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 ibis 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 certificates) 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 are 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 Accidenis. 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 mrmber on the appropriate lime.
City or Town Offidals
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 permittlicense 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 pd� been officially stamped or marked by the city or town may be provided to the
applicant as proof eat a valid a 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 burn leaves etc.) said person is NOT required to complete this affidavit.
The Office oflavestigations 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 Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www-Mass.gov/dia
Town of N. Andover
Massachusetts
DEPARTMENT OF INSPECTION SERVICES
CONSTRUCTION CONTROL AFFIDAVIT
As Per 780 CMR - Sixth Edition
BUILDING PERMIT #
PROJECT/OCCUPANT Heritage Green Apartments
PROJECT LOCATION/ADDRESS: North Andover, MA
PROPOSED WORK: Units 14-16 & 85-87 Balconv Replacement.
IN ACCORDANCE WITH SECTION 116.0 OF THE MASS. STATE BUILDING CODE,
I_STEPHEN J WESSLING TELEPHONE NO. 617-773-8150
REGISTRATION NO. 4191 BEING A REGISTERED PROFESSIONAL
ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND
SPECIFICATIONS CONCERNING:
ENTIRE PROJECT ARCHITECTURAL_ X _ STRUCTURAL
MECHANICAL FIRE PROTECTION ELECTRICAL
OTHER (specify)
FOR THE ABOVE-NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE,
SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE
PROVISIONS OF THE MASS. STATE BUILDING CODE AND OTHER, ACCEPTABLE
ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE
PROPOSED USE AND OCCUPANCY.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL
SERVICES AS OUTLINED IN SECTION 116.2.2 OF C.M.R. CODE AND BE PRESENT AT
INTERVALS APPROPRIATE TO THE STAGE OF CONSTRUCTION TO DETERMINE
THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS
APPROVED FOR THE BUILDING PERMIT.
I, OR MY REPRESENTATIVE, FURTHERMORE AGREE TO SUBMIT PERIODICALLY,
AN INSPECTION REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH
ANDOVER BUILDING COMMISSIONER NOT LESS THAN SEMI-MONTHLY. UPON
COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE
SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR
OCCUPANCY.
C ,�• Q
NO
QVINSC ,'..
& STMP (NO FACSIMILE)
Town of N. Andover
Massachusetts
DEPARTMENT OF INSPECTION SERVICES
CONSTRUCTION CONTROL AFFIDAVIT
As Per 780 CMR - Sixth Edition
BUILDING PERMIT #
PROJECT/OCCUPANT Heritage Green Apartments
PROJECT LOCATION/ADDRESS: North Andover, MA
PROPOSED WORK: Units 14-16 & 85-87 Balcony Replacement.
IN ACCORDANCE WITH SECTION 116.0 OF THE MASS. STATE BUILDING CODE,
I_ STEPHEN F. ONDRICK JR TELEPHONE NO. 617-472-1800
REGISTRATION NO. 39029 BEING A REGISTERED PROFESSIONAL
ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED
THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS
CONCERNING:
ENTIRE PROJECT ARCHITECTURAL_ _ STRUCTURAL_X
MECHANICAL FIRE PROTECTION ELECTRICAL
OTHER (specify)
FOR THE ABOVE-NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE,
SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE
PROVISIONS OF THE MASS. STATE BUILDING CODE AND OTHER, ACCEPTABLE
ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE
PROPOSED USE AND OCCUPANCY.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL
SERVICES AS OUTLINED IN SECTION 116.2.2 OF C.M.R. CODE AND BE PRESENT AT
INTERVALS APPROPRIATE TO THE STAGE OF CONSTRUCTION TO DETERMINE
THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS
APPROVED FOR THE BUILDING PERMIT.
I, OR MY REPRESENTATIVE, FURTHERMORE AGREE TO SUBMIT PERIODICALLY,
AN INSPECTION REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH
ANDOVER BUILDING COMMISSIONER NOT LESS THAN SEMI-MONTHLY. UPON
COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE
SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR
OCCUPANCY.
�OFM
STEPHEN F. G\
ONDRICK, JR.
#39029
STRUCTURAL
TURE & STAMP (NO FACSIMILE)
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Location
No.
Date ,/ // -�/
,.ORTol
TOWN OF NORTH ANDOVER
� • OOL
9
Certificate of Occupancy
$
J••° • tt�
,GNUS
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # A�
Buildinq Inspector/
TOWN OF NORTH ANDOVER BUELDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
-:'.., ' ,J -.. {x_ fir. This Section for Official Use Onl
BUILDING PERMIT NUMBER.��
C-)
DATE ISSUED,
a_
/d), -
SIGNATURE: f ('C
BuildinCommissioner/Ins or of Buildings Date
SEC'l'JON �� h~►1'i`lr' iI�'QRITIQ1�„,
1.1 Property Address
. -.
1.2 Assessors Map and Parcel Number. +
.3 9
Map Number Parcel Number
1.3 "Zoning information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area fl
-Frontage
1.6 WELDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
RIe red Provide
Required
Provided
ReqWred
provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. blood Zone Information:
Zone
1.8 Sewerage Disposal System:
_ Outside Flood Zone ❑
Public ❑ Private ❑tayy
Municipal On Site Disposal System ❑
2.1 Owner of Record
/ l
61';«lc�CJy
(Print)
Address for Service:
Telephone
T Authorized Agen
Na e ' t Address for Service:
i ature Telephone
3.1 Licensed Construction Supervisor
Not Applicable ❑
f�
AddressLicense
Number
LicensedC�r(struction Supervisor ;
Expiration Date
Signature elephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
_v"eLl Cc._
Address /
Expiration Date
,
Signature / Telephone
z
0
Ifs
■La
X
Z
0
z
M
SECTION 4 - WORKERS COMPENSATION (XXL C 152,§ 2546)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the
issuance of the building permit.
Signed affidavit Attached Yea .......i No ....... 0
SECTION 5 - PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES FOR BUILDINGS AND STRUCTURES SUW ECT,TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE ` HAND 35,000 C.F. OFENCLOSED SPACE)
5.1 Registered Architect:
1ia
Name:
Address
Signature Telephone
�.y a�c�taacf�u rcv1w33wnru �f�trnx['�S);.
—r--'� i �1�' S
rp � i c� 1 -4
Area of Responsibility
Registration Number
Expiration Date
Name: .�
Address:
Signature Total
Not applicable ❑
Registration Number
Expiration Date
Name:
Address
Signature Telephone
Area of Responsibility
.Registration Number
Expiration Date
Name
Address
Signature 'Telephone
Area of Responsibility
Registration Number
Expiration Date
Name
Address
Signature Telephone
Not Applicable ❑
Company Name:
Responsible in Charge of Construction
SRC"f l 3 'ii ,dFSCRtP'I">iQIV OF PROPOSED WORK (check. all appJica
New Construction ❑ Existing Building ❑ Repair(s)
AccessoryBldg. 0 Demolition ❑ Other 2 Specifv
Brief Description of Proposed Work: —
-��n,-lcl n C ti) rn ci c�
Alterations(s) ❑ I Addition
A '0e
db'rJ t a i. cn;^ C -4
.L�=•,�•. ,wtr �"v colvslRUc^rtorr
arxP».; ,
A Assembly
0
A-1 0
USE GROUP Check as a
licable
CONSTRUCTION TYPE
A-2 ❑ A-3
❑
IA
❑
A4 0
A-5 ❑
1 B
0
B Business
❑
C Educational
❑
2A
❑
F Facto
Factory
0
F-1 ❑
F-2 ❑
2B
0
❑
2C
❑
4HHazard
❑
1-1 0
I-2 ❑ 1-3
❑
3B
0tional
antile
0
❑
R residential
R-1 0
R-2 0 R-3
❑
4
❑
5A
S Storage
❑
S-1 ❑
S-2 ❑
SB
❑
U Utility
❑
Specify:
❑
M Mixed Use
❑
Specify:
S Special Use
❑
Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE
Existing Use Group:
Proposed Use Group:
Existing Hazard Index 780 CMR 34:
Proposed Hazard Index 780 CMR 34:
BUILDING AREA EXISTING if applicable) PROPOSED
Number of Floors or Stories Include
Basement levels
Floor Area per Floor s
Total Area s
Total Height (ft) —
Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑
SECTION 10a Owner Authorization - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I' ,as Owner of the subject property
Hereby authorize to act on
My behalf, in all matters relative two work authorized by this building permit application
Signature of Owner
Date
as Owner/Authorized
Agent
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Si under the pains and penalties of perjury
L?Z WC,/
f J
Pri N7e.
1
gate:o
Si tore of Own gent
SECTIQN 11K LS;ATE�I cCi1T5TRiTCTIOI' ('pT .
Item Estimated Cost (Dollars) to be
OYtP'IlL US:.t)ir'l.Y. _
Completed by permit applicant
1. Building
(a) Building Permit Fee
5 U
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction from (6
3 Plumbing
Building Permit fee x (b)
4 Mechanical (HVAC)
r ?
i�QCQ T l
Pt
5 Fire Protection
^{ (0dA
l7�
6 Total (1+2+3+4+5)
4
Check Number
NO. OF STORIES SIZE
BASEMENT OR SLAB
-
SIZE OF FLOOR TMBERS 1 ST 2
RD
3
SPAN
DEMENSIONS OF SILLS
DEMENSIONS OF POSTS
DRAENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CHDANNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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May -17-01 11:43A
P. 01
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APYL CAX1UN 'ru CUNS•rKVCt LtE? RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1.2 ilesecwxa Map and Parcel Number:
BUTI.'IaiNG PERMIT NUMBER;
22� Y
DATE ISSUED;
STGNATURE.
Building Commissioner/Ins for of Buildin Date - -_ 0 2—
l.1 Propaty Address:
1.2 ilesecwxa Map and Parcel Number:
867-87 Fifrrt-ioa.
,9 \3 F_
Name (Print) Address for Service:
Signature TClephotic
2.2 Owner of Record;
Address fix Service: - -
Signature Telephone
SECTION 3 - CONSTREICTION SERVICES
3.1 Licensed Ctmstruction Supervisor:
Map Number
Psruel Vumi>Lf
1.3 Zonotg lnformatiart:
1.4 Prnpety Dimmsions:
Licensed Constructiun Supervisor.—
Z.nLnA District Yr nrcd l hsc
—_
Lot Area
F'rcrita It
1.6 BUR DING SETBACKS 0
Address
Front Yard
Side Yard
Rear Yard
R iced Pravide
Reqcared
Provi&a
R
iced Provided
Not Applicable r 1
Company Name
/� -7
SEE
J 1 E r' T r! "�
—_-
Registt�ation Number
1.7 Water Svltply M.l7i_( .4f1. 1S)
1.5. blond Zane Whrmatinn:
1.1
km aw Litpwal system:
Public f I Private U !one
Outside llnod 7me 11
Maaidpd
0 Um site 136wal System Li
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service:
Signature TClephotic
2.2 Owner of Record;
Address fix Service: - -
Signature Telephone
SECTION 3 - CONSTREICTION SERVICES
3.1 Licensed Ctmstruction Supervisor:
Not Applicable n
Licensed Constructiun Supervisor.—
License Number
Address
Expiration Date
Signawre Telephone
3.2 Registered f fame improvement Cuntructur
Not Applicable r 1
Company Name
/� -7
SEE
J 1 E r' T r! "�
—_-
Registt�ation Number
. ....... _.
Expiration nate
SI nalLLt�c TC1C anC
1
c�
1)
L
May -17-01 11:43A
P.02
SECTION 4 - WORKERS COMPENSATION (ALG.L. C 152 § 25c(6)
Workers Componsation Insurance affidavit must be completed and submitted with this applicatioh. Failure to provide this affidavit will result
in the denial of the issuance of the building unit.
Si ed atliduvit Atrachod Yes .......n w.......11
SECTION 5 Description 0 Proposed Work cheek all oppikabie
New Con-tntetion I• I Existing Building R,-wir(s) yl i Alterations(s) 1 I Addition p
Accessory bl(lg. I 1 Demolition n (.HINT 11 (/-Specify
l;ricf Ek-scriptiott (1lfProposed Work:
R5 -i,-0 %) o - ,
SECTION G - ESTIMATED CONSTRUCTION COSTS
lcnn Estimated Cost Mllar to be Y' • •
am
�'4ttt lrtcd b ernrit a lic;ttrtl
,. alt.#
L
1' a Malt .ilig
1. Building () dil>g Permit Fee
2 G Multiplier
2 i71M-Irical (b) Estimated Total Cost of
Carrstructloit
a PlumbinBuilding Permit fcc ta} x (h)4 MechaTlic�al FIVAC
5 Fire 11rotectirnr
h Tota] (1+2+3141.5) Check Number
SECTION 7a OWNER A[JTHORIZA7'lON TO BE COMPUTFl7 WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
_ .. , as o mltT/Autho177.e(I Agcrlt ()f subject 1)T(Verty
I IerChy tnrlhorrue _ to act ort
My Ixhalf, in roll matters relative to work auQnorized by this building permit al)'11 ication.
Si natrnie of Own`T I)atc - - —
SECTION76 OWNER/Au,rHORIZEDAGEMr DECLARATION
.-,as Owucr/Authorized Agent of subject
property
I lereby declare that the sane inents and inth'ination on the foregoing application are true and accurate, to the best of my knowledge
and belief
!'Tint Name
4 Si)t+durcufOwner/A eat ._.. - _ ..— I)atc'— -. _ �. •—
NO. OF STORIFS SIZE
DASEMF.NT OR SI,AB
SIZE OF Fl.t-)OR TIM.13116 I 2ND
� .
KIAN
DIMENSIONS OI; SILLS
l)IMI(NSTONS OF POSYS
DIMF:NSIUNS OF 6lKDERS
I UAGHT OF FOUNt )A-VION THIC-KN1:-SS
SI%li OF 1001ING x
MA I FRIA1, 01;,('1 IIMNF.Y
IS BUILDING ON SOLID OR Fild.El) I -,AND
IS 13i}ILDIN(i (:()NNLCTED To NATURAL GAx LINF.
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Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax. (978) 688-9542
DEBRIS DISPOSAL FORM
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COCMICK.WK■
"4 0��4Tlo APp�y�S
In accordance with the proyisi ns of MGL c 40 s 54, and a condition of
Building permit# d SA the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in /at:
Facility location
Signature of Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
Name:
Ci1y Phone #
I am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
r`mm...es,
nu nam• f7rU �S V M 06 `rC10 5
Address LI 9, 21
Clty i-� F ti� M A O l 1 9 `t Phone # �7�%' cl 7S' Y.Y'U tJ
0
Com an name:
0
Citi Phone *
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,50C
and/or one years' imprisonment-aswell-as_civii..penaltiesin-theformnfeSTOP WORK_ R. DER.and-afine _ofJ.$1.00.00)A siay.against-me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature.
S -/2-a
Print name2t z ��-y k tig --1 Phone.#`���' >s'-s-� a o
official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensin
El Building Dept
[]Check if immediate response is required 0 Licensing Board
E] Selectman's Office
Contact person: Phone #: ❑ Health Department
Other
..........
DIVERSIFIED
.Aulson Roofing, Inc.
49 Danton Drive
Methuen, Massachusetts 01844
(978) 975-4500 Fax: (978) 975-0101
.Proposal
PAGE 02
Proprial sW6mttlad b: ,;.;
hone
Dato
Heritage Cxreen.Condominiunis
978-685-4434
4/12/01
Street
Job Name
Contact Penton
38 Panrwood,Ave,;Up t.WI
Karen Sourken
City, Starr and Z( (;ode
oLocation
N. Andover, 05
04
8%Fan
7 wood Ave, N. Andover
We he eby,�ropoke to furnish labor and materials to install new shingle roof to manufactures
specifick&)u,by ithe following
' 1114 estimate; covers the following shingle roof areas:
Entire -Roof '
Remove the existing (2) layers) of shingles and felt down to the wood deck.
The building will be tarped during the removal process.
* Protect,�
all �shpubbery as required.
Inspect for and replace any loose or rotted wood, up to 50 square feet at no charge.
,:
Any,addi,ional wood deck replacement would be an additional $2.95 per square foot.
We woiild�match the existing decking as close possible.
* Covcr en#m roof -with r51b felt paper.
All vaults t, :Ie weave4.
* Install ice and water shield 3 feet along the edge of the roof.
*
Install'ice'an'd water shield in valleys.
*
Thi sfiiti& will be installed by using roofing nails.
* The shingles thatwill be used are G.A.F. Royal Sovereign.
Your c6li:e*ofcolor: SILVER LTNMG - to match existing
* Install new vent pipe flashing.up to 4 inches.
* Re -lead the: chimney with 8" and 12" lead flashing.
* Install $ finch mull finished aluminum drip edge along all eaves and rakes.
InstaU a anew conceled plastic ridge vent to be covered with asphalt shingles.
* Remove existing roof vents, board up with 1/2" plywood and shingle over.
* Chan gutters:
* Clean ani -remove all outside job-related debris. We may require space for a dumpster,
* Provide ,standard 25 year shingle manufacturer's guarantee.
Provide standard Aulson Roofing, Inc. 5 year workmanship guarantee.
* Carry all'tmessary worker's compensation and liability insurance.
Contract
Isidro removed m the
the coit wvA be an add
5.00,
!v 'r C
n ¢` 6/1994 11:58 0000000000
Estimated By: Allen Rowe
— I-rrrrn
DIVERSIFIED
PAGE 01
PAGE 03
We propose hereby tofxrabh marartak ad tabor, eornpleti in accordance with abowe speeif iccdion, for the sum of*
Thirteen nousuncl, Seven Hndred, Twenty Dollars and No Cents $13,720.00
tVrnent terms are to'be as o ows:
* 1/3 deposit► 1/1 •wh= half done, balance on completion
All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according
to specifications submitted, per standard practices. Any alteration or deviation form above specifications involving extra costs
will be executed only upon written orders, and will become an extra charge over and above the estimate.
All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry £ire, tornado and other
necessary insurance. Our workers are filly covered by Workman's compensation Inc,,, me.
Note: this proposal may be withdrawn if not accepted within 30 days
AULSON RWPTNG, INC. AUTHORIZED SIGNATURE l/t [i✓
'EPTANCE OF PROPOSAL- The above prices, specifications and conditions are satisfactory and are hereby accepted
are authorized to do the work as specified. Payment will be made as outlined above.
Signature
of Acceptance 446)
Signature
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