Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Building Permit # 4/6/2015
,00RTF1 9 BUILDING PERMIT Oe�y4p° ' �e ...:.a.....': TOWN OF NORTH ANDOVER ° 00, APPLICATION FOR PLAN EXAMINATION Permit NO Date Received m �s9a°0,,Te°�Qa Sq9 Fc Date Issued: L & ( SgCwus IMPORTANT: Applicant must complete all items on this page f �( � ��r l � ���, r f��//r /� / r/ it / /�/f //��/// ��/ ✓rI/ //, r / / G. ,. -� -�/�. I� ,.r r /� � ,.. ., .r /�1��/r�%�+7� w"✓ ,,...,U r � �/ � rrr r,/ MR / / r e/ r /./ / / r/ / r ✓ / .../., ,,o 1, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial Of Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i //,/ // li, 1r ✓/ / /i' r„�,S� , r r r � r ,r ✓., , r r ..�,r I � //i r a , r / r lei r Sko elkcdi,� Yknjle Yx, 111411 X11 OWetq,� 41/. la oer A lit geld a,eCn.r G441ey. Identification Please Type or Print Clearly) w OWNER: Name: I-e A S` Phone: Address: 4"IVI�°f® 141 Zlleo kw,? AN lglol ( l // iii i I / r ✓ /// / / «� / ,- �i r / r. ✓/ ,r / ,r rr.r r,/r / RO 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.: CA NOTE: Persons con rac'M unregist eel contractors do not have access t , the r fu Signature of Agent/Owne Signature of contractor 7,77 IF own-1 An' ' over 'M `trA ,"�`` rl • b6 LAK. ver, Mass, CoCMIC"EWICK y�• BOARD OF HEALTH Food/Kitchen PERMIT �T LD Septic System THIS CERTIFIES THAT �- a... ........4.,-AS................................... BUILDING INSPECTOR ...................... . ........................ ..'..... Foundation has permission to erect .......................... buildings on ...�- .. ......... n:!�. !�. '...............° Iacce2pti-n- xgx-i; Rough tobe occupied as ......... .....:+...... ......................�....... ................................................. Chimney rovided that the erson ermit shall in eve res ect conform to the.terms of thea licationp pp rY p pp 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION AR S 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. / r /k ';; ,..ri /iii ✓�, . �%.,�,,/ii,��„ aijo,/i �y i MILL STREET P.O. BOX 1245 + WEBSTER, MA 01570-4245 1-800-427-99 FAX 505-943-9955 508-943-9973 March 23,2015 Randy Kehs Lehigh Gas 645 Hamilton Blvd. Suite 500 Allentown PA 18101 484-201-7831 c 610-625-8044 o rkehsk-)Lehigh Xas.com RE: BP Gas Station North Andover, Ma 785 Turnpike Street Dear Randy, The following is our proposal to replace the shingle roof on the above referenced gas station as outlined below. Because the pitch on this roof is only a 2.5 pitch we recommend and have quote installing Grace Ice and Water shield over the entire roof deck before installing new shingles. Grace is a far superior ice and water shield than Certainteed, GAF or any other product we have come across in our 32 years of business. Scope: 1. Remove and dispose of existing shingles. 2. Replace any rotted decking if any is found at 1.95 per square foot. It cannot be determined how many s.f. is rotted, if any, until the shingles are removed and the decking can be examined. 3. Install Grace Ice and Water shield over the entire roof surface. 4. Install F-8 White aluminum drip edge around the perimeter. 5. Install Certainteed LandMark AR M architectural shingles over the prepared surface. 6. Install matching hip and ridge caps. 7. Includes cost of building permit. 4, Cost: $14,219.00 Aftefe.-G( Submitted By: Todd W. Jankowski �� The Commonwealth of Massachusetts Department oflndustrialAccidents X Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Le ibl Name(Business/Organization/Individual): lea Qpp Un kms kc Address: _�p _FavX 1 Z.4Z Z.(, At It s{ City/State/Zip: bJ Siz+; PA Q65� Phone#: Sc,% 94S iq/'a > Are you an employer?Cheek three appropriate box: Type of project(required): L0 I am a employer with 1 FS employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. F1 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.n I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ p 6.n We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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. tContractors 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 atrz an etnployer that is providing ivorlcers'compensation insurcatce for my employees. Below is the policy all d job site information. Insurance Company Name: A.-TA. /A(,L14U0 IV ISU-faw-p- Policy#or Self-ins.Lic.#: AWC qpo®7O-;5zzo S Expiration Date: o")-Ti I 1 Job Site Address: I S 5 Tu,s %\c-e City/State/Zip: I.lV1r* �P_d uv- C, A\ U l '45 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify render thepains andpenalties ofpetjuty that the informationprovided above is true and correct. Sign re: Date: '� t Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/6/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CO CT NAME: LIZ Saari Herlihy insurance Group PHONE (AIC, EXt;508- 56-5 59 I A/c No:508- 51-57 7 51 Pullman Street gIESS:C Worcester MA 01606 DDRificat s herl'h rou . INSURERS AFFORDING COVERAGE NAIC# INSURERA:IronShore Specialty Insurance INSURED APPLI INSURER B:Safety S a Ce Company Applied Roofing Systems, Inc. INSURER C:N tional Union Fire Ins. PO Box 1248 INSURER D:A.I.M. Mutual Insurance Company WEbster MA 01570 INSURER E:Evanston Insurance Co. '.. INSURER F: COVERAGES CERTIFICATE NUMBER:2068908031 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICYNUMBER MM/DD MMIDD/YYYY A GENERAL LIABILITY RCS00028000 /1/2015 /1/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESS DAMAGE ( a TED Ea occurrence) $100,000 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ '.. B AUTOMOBILE LIABILITY 6232030 /1/2015 /1/2016 Ee accidents G E T $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED Pe a cidentDAMAGE $ HIRED AUTOS AUTOS $ C UMBRELLA LIAB X OCCUR BE016827019 /1/2015 /1/2016 EACH OCCURRENCE $5,000,000 '.. X EXCESS LIAB I CLAIMS-MADE AGGREGATE $5,000,000 DED I I RETENTION$ $ D WORKERS COMPENSATION YIN N AWC4007032205 /1/2015 /1/2016 X WC STATU- O LI IT ER AND EMPLOYERS'LIABILITYITH ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 E Pollution Liability 15CPLONE60562 /1/2015 /1/2016 each CGL Limit 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) '.. CERTIFICATE HOLDER CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Bulding 20,Suite 2035 AUTHORIZED REPRESENTATIVE North Andover MA 01845 l /l ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i I i Office of Consumer Affdirs n Busi�%gulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improveontractor Registration Registration: 105499 Type: Supplement Card APPLIED ROOFING SYSTEMS, II ` Expiration: 7/17/2046 STEPHEN JANKOWSKI 26 Mill St. ,til . Webster, MA 01570 J: Update Address and return card.Mark reason for change. SCA 1 �`a 20M-05/11 Address ❑ Renewal [:] Employment Lost Card tp rrnzd�acuetrl Vb1l6madmuelf. Mee of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e istration_ �� Office of Consumer Affairs and Business Regulation 9 45499. Type: 10 Park Plaza-Suite 5170 Expiraan 7/-1 7120 I 6_;. Supplement Card Boston,MA 02116 - APPLIED ROOFINd SY$"TEMIS;INI . STEPHEN JANKOWtK!', i PO Box 1248 Webster,MA 01570 Undersecretary of val* t ut signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards C"wistructioll Supervisor License: CS-089868 ?' tii STEPIEIEN J aAril bw 1 l 33 HENRY MARSH t DUDLEY MA 0171 ✓..�,.-.J.�`-.�-'jr I A Expiration Commissioner 10127/2016