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HomeMy WebLinkAboutBuilding Permit # 4/16/2015 I i BUILDING PERMIT o�"��T 6 TOWN OF NORTH ANDOVER O� ye xb O APPLICATION FOR PLAN EXAMINATION '" ' _ 70 Permit No# - �J Date Received areo gSSACHUs�� Date Issued: V-& PORTANT: Applicant must complete all items on this page w` _.fir t „s x,� ^r r� ."�s 1x";ra"�,`l as l.:�r f ',' �A d»kr. �"..';,-�.�✓ sFsuz+ ......�� ,,:r., .�'f'' trf„� .5+, .' � �.'�,. 7 r :1i'e �.✓ �' r�i`.. ,�.�t�'_,r:`y�"..,:r�rr N,�s f t ry i`rz r,`. r d .r�",:.;.Y` f rr r.,, �" I�..O�BION `�fz4:..ra� ,,;rn'' w;r'.�k`ux»�},arrr° f a5, 4��4.. ✓r/i P������;� .�.,:4'i;:�..,.^fr�rs���r,���� r`���.rtrhf rf" ;r��t1; �r fty r;,,: tf ON 14 �r �PRQ E . VY'I�ER�� a � a„ � n 1,r5i '^° . : OD ea,St cure ;; esr oto^ s �.. � ”.� tx"�,'M�,s,�,�,a�u�Y,ty, e�^�`.rv.M✓'„�j '�`a r ,'�s: r: xr'r r <tr ..<. s s ,+'` ::: x .4 r..� r r yn,"� .rv.-`3q r� rx y�` mss "*. ,r. !'Y! f ;-a^� f'^f£�'! va'r-r � ''✓t rrr x1r,�i t l '�i' '�+�:rl� °�.li,�;"" „�..r! rr � � a'"�.rk:�-:�r y����,�-��7<.�t�.'� �l b..,,�'r,=� �.,r. ,,,;,,: :,x a..�`c 5:� ,,rs';., ' !t ��- x s::,�rf r�r;�: �` � .7.• ..,�� �„r;,. ,,r„ n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ,<One family ❑Addition ❑ Two or more family ❑ Industrial O:Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r Nf f }Se tic '❑rWell ' Flood�]Ia n r ❑ W, d' ,r ❑>1/l/atershed District f a r, 2� r:: .x".sPturri" Ci- rr.�'r r„Gw::, r",1:-.✓ al... r` tf r:, '�',�'"�'r:"�'z=:^. � P�d�i....,r ,r : tk�.s- `,:,",�":�"'r x.,-.zaat,.�.;"ar tur'f .,✓r r' t / r� � ,i^ ,, tr' �,d�rr�l`lrt.,:.^y,-.1r ter" .5".0 4?;...a'� �t.rr l trfr 1`r �! -� ,�.;, ,...� �,f^.'.:; . .1� ✓ .'':m a.p ` ,� � `.,a` /`SUF y�.r'�':,x�',�, -sr j,1,,,'�"!rfc.!'`xr�,rc,^1,3,.,7+��`.•,".:�:j;`r..�"�,��'�.�`s,"f�s'�r j,r t .:,,; ,� c,�,�.s,;,, �; DESCRIPTION OF WORK TO BE PERFORMED: Identificatio - Please Type or Print Clearly OWNER: Name: r�v:'1� i Phone: ..� Address: .�sus r �:yr ;:'I r� F r � .x.x `x.rr _�? r r... �f✓':r ;;t r' � r..ry�-� x,n `,..'r r r, fi-,rr x BI:Lr r� .r- t .'`r ✓..rrr r ...r' "l .=x' << r:. f. F t,.e: -xkx'r f S r ro?�' I` r`vs frsyJ.; �:,., ✓ l ,u, "' i"ssrb".fi r r.,;.,!'..;fi.,"..,r ,:f. rf �r r z � � ., t�::*n:-r'4.�rXr£�'""-.:G'L bF�S-: �"'td��...: `•` y. .,�`rYy 1' fi rl,+ .£�J'.iK;" f 5 1..-;: r,,'C".<' 's`�.!.s" .' //f,�u'u � r'` / ek .r:,� �$��'�`�":'�,.':t ✓ .,,j�r s. r .,s.- : r �/ tr ++✓r rsr rrt z r u rt f1}rrfrJ.,`'r'"'xrn r.x'rlc',:�;,rrr✓f r,Contractar�rName �,�, �� � s'",u'�r-!�u'1`/`:�°t '.d.-:' �i`� �� e r �✓k.. a .w.rT r.-., .. -r- ,:"_51r r� l r ,fir' lyes-�.:�. ?" ,lf" r sr5 v ✓�:',��j ,r"rf ':.r'!F':�;r,,lam-�- f .,s rrr�*,^r 't` .acs✓✓rrrjsirF:. fik'�,frj„r,"' 9 /u, rr f .d' rs r"'J ��r Pfr,r ,'e.;'. �'.r 1 5' �ti c'',�Xxrr�^s"� '�r�3'r�f'��,�`+.r,✓G.�✓`r�..§�a r�7 ,;: fiAc�d feS. 1an�r a�" � �?� 5 r'rru,.. �. � ,r7�'p�'i',"'��."" ,nY' ,�.�,�",.fra�,�r c'r�''.� � 5 � ��€',;s a �``�u,rY^`.c'�(�� �.�`'r .'rrrv.f.,�r`�/�r�1�� Fr��:�J£- 'x��:. ✓ =�'sr.,� fir„ ,s"'= ', '1'' � �rt^;.=! - r _;..t.rsa�-, r a "` _ _�-�"✓ mks �:"��,,�..,a' 7^ ���s��t'r-":;�� `z r�,,,s�`i'N� ���-`,%d :, .w��-, � ,u�'',,,hmA�4'� 1' .;, "�'�'''�if."1` ,rt 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: $ p FEE: $ Check No.: W Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access th an fund Signature;of Agent/Owner `Signature ofjcontractor "` r k tk®RTH Town of Andover ® : to No. i - ` �O LAKE h " ver, ass, �` - cocMicKcwIcK A�4ATED S U BOARD OF HEALTH PERMI �T� T L 1) Food/Kitchen Septic System THIS CERTIFIES THAT .. . �. ...�: let-1 .?............. . BUILDING INSPECTOR 07 Foundation has permission to erect .......................... buildings on .. ...... .... .......... ............ ....................... ® Rough to be occupied as ............ ......Cis ....... ...... .......... ... ......®............................................ Chimney provided that the person accepting permit shall in every respect conform 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 ® PERMIT EXPIRESELECTRICAL INSPECTOR UNLESS CONSTRU NS Rough Service .......r' D............... ........................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. CD Roofing Vincent Colangelo 3 Hodgson St. Roofing Tewksbury,Ma 01876 THERE'S NO ROOF WE CAN'T COVER 978-656-8497 78-6!!;!1 �� _ vincenteolangelo@sbcglobal.net • • � HIC Llc# 170575 CSSL Lic# 105943 i 00 OWENS CORNING Customer: �) C' �I t PREFERRED CONTRACTOR Description of work Performed: Obtain required town permits & provide certificates of insurance&workers compensation 9"Provide Dumpster set on planks*for contractors use only(materials all recycled) Attach Large Tarps to protect adjacent finishes, landscaping, and property. Strip-off( I ) existing layers of roofing on complete house& re-nail any loose decking ( . Install 8inch L.4 .Aluminum Drip edging/Owens Corning Starter Shingles ,0,Install Owens Corning Ice&Water shield 6ft at eaves, Xfln valleys, around all penetrations ( Install Synthetic felt paper to entire roof " (),'Install Owens Corning LifeTime warranty TruDefinition Duration shingles f4 Install new,neoprene vent pipe flashings on all plumbing pipes � Install Owens Corning VentSure ridge venting with moisture guard `W Install Owens Corning ProEdge hip& ridge cap shingles ( "Completely re-flash chimney with lead Owens Corning Preferred contractor installation with full warranty All work will be completed according to state and manufacturing codes and specifications. Every day we will have the roof water tight, clean gutters, completely clean the job site, and use a magnet roller to collect scattered nails. Additional work to be performed � :� �. t` f- Dor", b All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tomado and other necessary insurance.Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults, homeowner agrees to pay all costs of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of: dollars($ � ). Said amount shall be paid as follows: ov Note:This proposal may be withdrawn by us if not accepted within days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. Work will not begin until our right to cancel has expired and you have a id,a de sit of 9 Y 9 P Y PP�v dollars ($ ), unless this agreement provides otherwise:'" rr Signature of Contractor or authorized representative: z_ *(I/We) have read the terms stated herein,they have been explained to(me/us),and(I/We)find them to be satisfactory and hereby accept them. Signature of Homeowner(s): The Commonwealth of Massachusetts M Department oflndustrialAceldents X Congress Street, Suite 100 Boston,MA 02119-2017 SJ;ut www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Name (Business/Organizationitndividual): G " s Ad(hess: 5 11 �;U City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.F-1 I am a employerwith employees(full and/orpart-time).* 7. Q New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Ej Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F]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.Q Roof repairs "These sub-contractors have employees and have workers'comp.insurance,# 6.Q 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 theirworkers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must sutbmit 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 iiave employees,they must provide their workers'comp.policy number. I drn an employer Mai is providing workers'compensation insurance for•my employees.'Below is the policy and job site information. 4 ��,�,, Insurance Company Name:_ AA 4 G a4_1 ( �/�1r '�-' Policy#or Self-ins,Lie.#: G—C7'7] 'C__ q�, Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compei�saticfn 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 cer7lfy u�dep �s d penalties ofperjury that the information provided above is true/and correct. Si nature. / Date: Phone# �' Official use only. Do not Ivr'ite in this area,to be 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#: Ac CERTIFICATE LIABILITY DATE(MfWDD/YYYY) 3/27/15 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 CONTACT NAME: Angela Westen Insurance Agency PHONE Fax 978 735-4095 • (978 735-4094 No: ( ) 557 Central Street E-MAIL : angela@awesten.com Lowell, MA 01852 INSURE S AFFORDING COVERAGE NAIC M INSURER A:ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP FO CONSTRUCTION CORP. INSURER C: 40 READ ST. INSURER D: LOWELL, MA 01850 INSURER E: INWRER F: COVERAGES CERTIFICATE NUMBER: 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 AWL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/DD/Y MM WYYYY LIMITS A GENERAL LIABILITY L021008696 3/18/15 3/18/16 EACH OCCURRENCE $ 1,000,000 $ COMMERCIAL GENlERALLIABILITY DAMAGE TO RENTED E a occu a ce $ 100,000 CLAIMS-MADE F—I OCCUR MED EXP(Arty one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO- JE RO LOC $ AUTOMOBILE LIABIUTY COMBI(EaacNEEDiSINGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNJED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED P e0rPE Y DAMAGE $ HIRED AUTOS _AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLLAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B NWORKERSCOMPENSATION 2E112068 3/30/14 3/30/15 WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 H yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rerrarka Schedule,If more apace is reciul red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CD ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. VINCENT COLANGELO 3 HODGSON ST. AUTHORIZED REPRESENTATIVE TEWKSBURY, MA 01876 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: VINCENTCOLANGELO@SBCGLOBAL.NET p�ll//1Z04LlUeCcL�ft Ccc{LUJe�O /e �. Office of Consumer Affairs&BusinessRegulation ME IMPROVEMENT CONTRA Type: egistration: 170575 DBA xp i rati o n. 11/10/209a CD ROOFING VINCENT COLANGELO 3 HODGSON ST TEWKSBURY, MA 01876 Undersecretary Massachusetts - Q p artrn ra of Wublic �- Board of Buiidinct R 'afions-and Standarc£s ContitructioillsuprtNi.eurSpecialkt 6 License: CSSL-105943 f VINCENT COLANGELO � ,. 3 HODGSON STREET Tewksbury AIA 01876 r"—I,-,"' .y 03/09/2016, ii