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HomeMy WebLinkAboutBuilding Permit # 4/23/2015 {SORTFr li ,fit,.-„o i6 g1r0 BUILDING PERMIT �� y�: - '` '° TOWN OF NORTH ANDOVER ° o APPLICATION FOR PLAN EXAMINA ON Permit NO: m' Date Received ACHU`����� Date Issued: V I IMPORTANT: Applicant must complete all items on this page I � S4 LOCATION 6 (- Print PROPERTY OWNERr b Print MAP NO: 6'1 C) PARCEL. ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 3 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ! One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial TRepair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other El Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 0 Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: = 6� Phone: �50':i6 1256-6 Address: 256- Address: (Q���Se S� 06e-4h 1c If_yVe► CONTRACTOR Name: t 7 Phone: 62 &S7:--/D �((��IC �(1LYY1YriO�I Address: Supervisor's Construction License:a � Exp. Date: L 0 Home Improvement License: Exp. Date: a 201 (9 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: $ in noo . ocp FEE: $ r - Check No.: L_P Receipt No.: V(oq NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner' _ tontracto6) � F FORTH Town oft nduE. :..'.,,. c 0 Sell" i 145 41 • n4 - -;"h ver, Mass, O LAKE COCKICMEWICK A°RAreD jk? U BOARD OF HEALTH Food/Kitchen tjERMI D Septic System THIS CERTIFIES THAT ......................... .... . .......................... ................................... �............................ ................ BUILDING INSPECTOR 4 Foundation has permission to erect .......................... buildings on ........ .......R4A � .... . ...t .. ® Rough tobe occupied as ....... ..........4.. ... ..... .. ........ .............................................................. chimney provided that the person accepting this 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C CTI TART Rough Service ............ ....� ........ .. .. .............r............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Islay 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. The Commonwealth of Massachusetts Department oflndustrialAccidents d I Congress Street,Suite 100 Boston,MA 02114-2017 wipmmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 72 T C Address: City/State/Zip: ,� �` D It L Phone#: Lt 1y2� Are you an employer?Check the appropriate box: Type of project(required): 1.dam a employer with _employees(full and/or part-time).* 7. E]New construction 2.F]I am a sole proprietor or partnership and have no employees working for me in 8. F-I Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F-1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q 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. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.rJ 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. #Contractors 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 employee•that ispf•oviding workers'compensation insurance for•rrry employees. Below is the policy andjob site information. _ Insurance Company Name: Policy#or Self-ins.Lie.#: \ \ Expiration Date: 0 1 Job Site Address: � �p ( J� City/State/Zip: 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. Ido hereby cer ify under the pains and penalties of perjury that the information provided above is true and correct. _ Si nature: W Date: I�� -2 6 Phone#: C1 1 6 _6`22S (C) 1) 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: PRECI-5 OP ID: ES CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/23/2015 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(ies) 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 Westford Insurance Agency NAME: Eric Semple PHONE PO Box 308 WC No, o Ext:978-692-3073FAAX No; 978-692-0429 Westford, 01886 E-MAIL Eric SempleleSS: Eric@Westfordlnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Insurance Co INSURED Precision Roofing, LLC INSURER B: PO Box 653 Acton, MA 01720 INSURER C: INSURER D: INSURER E: INSURER 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 ADDL SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR NPP8115189 06/07/2014 06/07/2015 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 9 'las;six-,hus tts -L)e partvne nt of Public,Safety Board of SWstiing Regulations ar',W Standards t`oNuvm-uc&ion Supeu•wiso h_oc,ense: GSSG-099691 Y ERIK B HAMMAIt 9! r.. PO BOX 653 'M ._ ACTON MA 01720 Expiration Ceonurvissioneer 10/17/2015 ('(„.o•or�,�r�r //, License or registration valid for individul use only office of C'°nsnn�er Affairs&Business liegnlation } before the expiration date. 1f found return °' SME IMPROVEMENT CONTRACTOR Type: office o Ph Consumer n u ere 5170Affairs and Business Regulation X-' �gistration: 130275 1 expiration: 219/2016 Ltd Liability Corpc?di g,oston,MA 02116 PRECISION ROOFING LLC r i Erik Hammat of valid without signature 126 NEW ESTATE RD Underseereuuy LITTLETON,MA 01460 i -FIs Y d # Customer/Homeowner Name Company Name Albert'Taylor Precision Roofing, LLC MA HIC # 130275, exp. 2/9/2016 Street Address/:lobsite Contractor/Business Owner Name 60 Russell St. Erik Hammar MA CSL# 99691 (RF, WS), exp. 10/17/2015 City/Town State Zip Business Address North Andover MA 01450 126 New Estate Rd- Littleton, MA 01460 Da il]1e Phone 508-2654853 Mailing Address Evenittg Phone P.O. Box 653,Acton, MA 01720 Kptaylor219@comcast.net Business Phone 978.63 5.1023 Federal Employer 20-2820250 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor agrees to do the work, and to furnish the materials, described below for Homeowner: • Acquire all necessary permits. • Install tarps prior to shingle removal to protect the house, landscaping, decks and A/C units. • Strip off all old shingles from roof, de-nail substrate and repair/replace rotted boards. • Nail off any loose substrate sheathing. • Install]Premium .018, 8-inch mill finish aluminum drip edging along all roof side(rake) edges. • Install new mill finish aluminum vent pipe flanges. • Leave in place and re-use existing aluminum step flashing where rooflines join vertical walls. • Install new aluminum flashing around chimney under/behind existing lead flashing. • Inspect existing lead chimney flashing for adequacy with Contractor's 10-year Warranty. • Install Air Vent,-Inc.'s ShingleVent" II ridge vent at all ridgelines, per manufacturer specifications. • Apply a 6-foot width of Grace Construction Products' Ice and Water Shield° underlayment as follows: along roof bottom edges; up valleys; around skylights, chimney and vent pipes. Application will extend under existing step flashing. • Install Manufacturers Synthetic underlayment over remaining exposed sheathing. Installation will extend under existing step flashing. • Install CertainTeed Landmark/Owens Corning Duration Limited Lifetime architectural roof shingles of select color, following manufacturer's application specifications. • Install CertainTeed/Owens Corning factory enhanced starter strips along eves and rakes and factory enhanced Ridge cap. Increasing wind warrantee to 130mph. • Fasten.roof shingles with six nails per shingle following manufacturer's nailing pattern. Nails are galvanized steel 11/4"by 1/8"smooth shank with 3/8" diameter head. No staples will be used. • Clean and sweep jobsite daily with a magnet. • Remove old shingles and related debris from job site. • Clean jobsite grounds upon completion of all work. described. • Leave two bundles for home owner when job is complete. Homeowner's Initials l I of 2 Contractor's Initials OTHER CONDITIONS,WARRANTIES/GUARANTIES, WORK SCHEDULE • Work area to be completed:is the entire main roof and garage. Exposed areas will be protected from inclement weather. • Total Contract Price includes replacement of two(2) 1"x 8"rough cut spruce barn board. Additional board replacement will be $3.00 per liner foot, installed. • Price to replace rotted or broken trim boards will be $5.00 per linear foot, installed. Replacement primed pine board dimensions will match existing trim boards. • Total Contract Price includes disposal fee for old shingles and related debris. •;;' CertainTeed's Limited Lifetime Warranty on shingle materials is per Homeowner's registration available online at www.CerLainteed.com. • Total Contract Price includes Contractor's 10-year Warranty on labor covering any leaks associated with poor workmanship: chimney-roof flashing joints, loose sheathing, raised nails, low nails, sunken nails, bent nails, improperly installed ice and water,paper, or shingles. • Precision Roofing, LLC is not responsible for existing hidden damage, excessive rotting etc., and if discovered will cause all work to cease until there is an agreeable solution between both parties. • Permit cost vary greatly from town to town, permit cost will be additional to the final bill based on your towns rate. • The following schedule'will be adhered to unless circumstances beyond contractor's control arise: Work Scheduled To Begin: 1/12/2015 Work Scheduled To End: 1/13/2015 The dates above are ballpark time frames. An exact date will be given upon the return of this contract. PRICE AND PAYMENT SCHEDULE Contractor agrees to perform and warrantee the work,plus furnish the materials and labor, as specified above, for the SUM of. $10,800.00 Homeowner agrees to make payments according to the following SCHEDULE (Cash, Check,Visa, MasterCard, American Express and Discover are accepted): (American Express will be subject to 1.5%surcharge) 1/3 upon signing the contract. 2/3 upon completion satisfactory to all parties of all work described herein. All home improvement contractors and subcontractors shall be registered in Massachusetts. Inquiries about registration should be directed to: Office of Consumer Affairs and Business Regulation Suite 5170,Ten Park Plaza,Boston,MA 02116; 617.973.8700 Homeowners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. A copy of this contract will be kept by the Company and should also be kept by the Homeowner. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Homeowner's Signatures"` 7 D t�e / Contractor's Signature Date Homeowner may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided Homeowner notifies the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,no later than midnight of the third business day following the signing of the agreement. Precision-Roofing, LLC www.precisionroofing-llc.com 2 of 2