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HomeMy WebLinkAboutBuilding Permit # 4/16/2015 I BUILDING PERMIT o���oT b�wo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION A _ U K. Permit No#: I Date Received 7RA"ATE, "` 5 P Date Issued: IMPORTANT: Applicant must complete all items on this page r r-rv--,:- �; ,,-z STs-'„ -,v s...vr -,;r k r _ .„ .- r'L` r.,„,,: ;�z trr.,,r rxr„n ,yr r* rFr ::r; n' .?�' abdir.,s,r,r-":,:�r$rr`r-,.uP';`kx'".,r,,.,sw.;a.-...'�d---%' rc ,,4r,,.r„r✓rs'*�.r!r�,�.�'tr,.;,,�,.r�„U�'rf.t f�-.r�r-'m�a�.h`r;�`�37L..r�r'�r',r�;r-..�,��'..�r�'�r,r-.s r F�„�r..r1�r�a(Zrrr3r»r r'' rar�,�fmrrf`..ur,.`/.�r�`rf� fir-I`#�'-' fir`'r"'` g1Fi'.u`r.�;.r�JF�K,rrr'.,,l,r r w',�.5sr=,.:,�..rr%s'�`y':r,I.�f„,a:,t rnrrrr`rr/r''i""`„�,✓v.f-,.,. r•;.,, fat` :� .,„r'.,,, " ..r��fi Frr f ���� !' rr �� 2`u-:w� "� Y�Y i^�1l� �✓�i�,1�`'{J P r�✓�rri1. � � r'�t �xlr ��. t� ,. �r - z r �; , ,_ f;� ✓r�'r rt'� �" Pr'' �' - ✓r'rrr,i�, res r r �' � i. a, :,�_� rl rte, r,F rr rn✓A:.,�wrr�.�, ^�,r�,,r,.,:,�5 y r y�r�i' r y,:..7x rub' �?f ez- � �:r`!=..,`",,y'-J' �r''fr r,�. ...�i� ir!` ^,7��`-,, MAP- PARGEL, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial IN/Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other n 1Nell r% a ❑ Flood tarn ❑Wetlands f {❑ 11Uatershec District rr�,rr- s't" ::�" r .r✓t� r- -..:r p;< s ✓` r l k� 1 :sr �'r�' r �,r'�""rr^.rrr f�"£I ',?„„,. :�rrr �l`:;„. � t,„...,.. �.��: rrG";.�.r":: r. .ri. 6` c`..r .? U f d ✓ :.y 7 t 1 {i' r r /' � ;`�P,'. ” k ..err r rr`'. ,�i r� ,. a•7,rx„ . _,.wm,,:, - Y,<,. ,:.,:_.:r.c:,�,7sc,, . ,J, r:,ns.:. » ,._ ,r.S .. .,,�,. ,.a �'.»5,'�'.,?':�,� rr„r .,ii. �y DESCRIPTION OF WORK TO BE PERFORMED: 2 3 0'�4- 0 cod-i z-S Identification- Please Type or Print Clearly c� OWNER: Name: ria Phone: 9 78 b rCt Address: rr„- ��:$ nom. :ter,t fia ,/. r r fir. 1. r a�rutil ,.,� I✓..-� � r <'t fa'-`.r,f r.,;-:7 .r..r-,' r -r✓ �- r r ,acr .>=i' s-` � c;1 :�r '.e” / G ��a{r're�"v� r?/ "�$'.r' � rr%�:��`l ,,r^ �,trr r r -,c r t �r'- r1✓ r'f t.r y c K;.x ^'r'v Y .7 a �,Ic.$F �.�' FF i�r 1r;;w r A Hr�Ys'r�.sy✓. .r.%Yr �{�zr f�,`r'r� �, rr`rs`.,rf rr:rs r �4J ..rJrr: f,:7f.»;.rr r`"rr,, "n 'r r ry:'�� ,.� r'r,�;�,r �y� �`�`�t„�1r '�s,'- �`C�antracfior�Nar�e��� r,_„ C'±' �✓r 9Y r3'�..:3% �r�� rr= ;tf r r ' r .,$, r'k rr^'1Y`.. ���r.r 1u ^'�:Pi'``�t�r ':;r'-r''. xEmarl 7r .r&������r�` '�rr'��rr�'w r���l rrre lfrY' r:j r � $7��efit�r ;r Y rr lr r r ''� � rt rr�r�ic✓ r�r» �� rr'r � ,�x�"x"r,'�,x.' -E`�.'w. a g � .rs+ 7<��r r'�,r'hk"v f rf Y:v=,r r,f✓l�rr ;:r.r�F,r ,�kr..i,: r r� <:r'� Y4��r,y ;�r.^r:� r�.rr;='i�'r`r``r ,r`��7s�"'.. €`"'.. °'fir..a � �.rr¢rrr�..r�'; � ,?�rr� �_r �" r aJi-:2Y�._ -rL ylr �r✓r�r� "' a r�'r �`r � rr� 3f Y�rtr»ter.. " alkf.i.�ff'�� r�r ¢��� �A CI'reSS"�� "' � �f'�r' '�,r /�' � �� ��lr r� r � �r'��r�r✓{,r rr.,,k $Y, .;.✓ r,r #z+r' r r rf: ,r �.;..'a�r^,e _ '`��Y. .r>�6 fr'.��✓ Via.r ,x no.",-.. rr},y��r �r'v"��r-„r r .�'.yr4r y r :lrrJ,��,��3'. ,� :��,'r'` �Y�'. ."� .j .`�. � ,rr,✓r` r �" r ,.��1 t'•fi;� a� r�.9�� �r i ,{.. �t T�-�.r.,.,�1 rf �-<�,,`�j�r�',tr y�.3`�rs� vr � y Y v ,r ., ;,.. �„�';' r f r r~,�;.. r�tr i�-� „r r' y.rr Jr r $� ,�✓ e„ ��. ':.,_, a .l.��t..r� ,�.t`$'r1?�»2`fi „�.krs..,a� ��,.�� � a�:i�r� fj:'rY,nl, :�r�',.;: 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: $ U FEE: $ Check No.: 9,, Receipt No.: P NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ; gnature of contractor ; - I N®RTF► Edover ® - ` 0 . i - . C, h verass •�« O LAKE ' ' COCKICMl WIC K_ AERATED S fJ - BOARD OF HEALTH Food/Kitchen ERSeptic System THIS CERTIFIES THAT ............................................................... ,, ,, ,, ,, ,,, ,, ,, ,, BUILDING INSPECTOR ........... .... .. . .... ....... S . �has permission to erect ........ buildings on ... :, „ Foundation, Rough tobe occupied as ......... .. ........... ... � . ..................................................................... Chimney provided that the person acceptin 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 PERMITIES MONTHS ELECTRICAL INSPECTOR UNLESS ST TIO Rough Service Fina U.LDINGI.N TO 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. GCL CONSTRUCTION PROPOSAL project roofing City..zip North andover attn rosemary Address 63 holly ridge rd company Gel construction Bid date 04.09.15 Tel/fax/cell Heard of us by friend Based proposal as per attached scope of work: Alternates:Any Additional customer requested carpentry work will be billed at per hour+material. Proposal to remove 1 layers of roofing and replace roof shingles secure required building permit protect building and grounds remove and dispose of existing roof shingles inspection of sheathing and penetration Flashing renail loose boards as needed sheathing rot replacement priced at$60 per 4*8ft masonry work chimney re-leading included warranty from labor, install new pipe boots install new ridge vent On roof install ridge cap ?-dr Ice&Water-shield 6 ft from edge install new aluminum drip edge on perimeter of roof and eaves areas install new 30 year shingles certainteed select shingle master warranty 5-star coverage upgraded wind warranty 110mph or 130mph clean roof gutters and downspouts thoroughly clean grounds daily of any roof Shingles type color to be determined at meeting with contractor T ` Note:Price only valid for 14 days. PAYMENT: A non-refundable deposit Of 1/3 of ALL ACCEPTTED PROJECTS is due upon authorization is the amount of_$_11. 50,00 with the 1/3 of EACH PROJECT, and the balance of EACH PROJECT due upon compleof each project along with any addition work requested by customer. DISCLOSURE: State law requires us to inform you of contact liens.Any Contractor, supplier or subcontractor may lien your real property if you or the general contractors fail to pay for goods or services delivered or installed at the work location. Some contractors and suppliers atomically send lettert -wewrli-provicte-originai 1rerrreivase documents from anyone who provides said material or services.Please call if you have any questions regarding liens. ACCEPTANCE: The signature on this proposal reflects acceptance of the proposal as per the attached scope of work, authorizes commencement of the work and hereby guarantees payment as outlined above,Any amounts not paid within thirty days of invoice are subjective to service charges 1 %2%per month (180/oAPR).All cost of collections, including reasonable attorney fees are to be paid by customer. You may cancel this transaction at any time prior to midnight of the contract amount if the job is cancelled by customer-after three business day. PERMITTING: The signature on this proposal authorizes a representative of gcl construction to sign for and obtain any permitting necessary to complete this project. --- - ---- ---- ---- ome wnerBuilder Date customer signature Date The Commonwealth of Massachusetts f Department oflndustrialAccidents X Congress Street, Suite 100 Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individtid): 7Ci l/ lJ hgGT i of Address: 14\ U 0A nU 4_ 6+ QIA )47 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project()required): 1.[]J amaemployer with_employees(full and/or part-time).* 7. ❑Nowconstriction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F1I am a homeowner doing all work myself[No workers'comp.nlsurance required.]t 10 ❑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 withno 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.instuance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks b6x91 must also fill out the section below showing their workers'compensation policy information. 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. fain an employer drat is providing workers'compensation insuranceyor my employees.'Below is the policy and)ob site information. Insurance Company Namer7(Z (' in (V(C/4zcd����rl�JGr7c/ Policy#or Self-ins.Lie.#: -7 `)�( � (,�E 051— Expiration Date: 3 / 19 / Job Site Address: i ' j City/State/Zip: /V • gaClo�C! ®�3�� Attach a copy of the workers'compe,sation poi y 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. X do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: 16 15 Phone#: F (—X) (2 696 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#: CERTIFICATE OF LIABILITY INSURANCE DATD/ 044/16!/16/201155 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: Finnerty Insurance Agency HONE o E.11: (781)337-1009 FAX N,I: (781)337-1171 1598 Main Street ADDRESS: bdan@finnertyinsurance.com Weymouth,MA 02190 INSURER(S)AFFORDING COVERAGE NAIL# Phone (781)337-1009 Fax (781)337-1171 INSURERA: PROVIDENCE MUTUAL INSURED INSURER B: TRAVELERS GCL Construction INSURER C: 102 Walnut Street Apt#7 INSURER D: INSURER E: Abington MA 02351- 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. ILTR TYPE OF INSURANCE IIN R sWVD POLICY NUMBER MWDD CY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 Q PRE COMMERCIAL GENERAL LIABILITY DAME Ea occurrenceAGE ( RENTED $ 50,000-00 A F] F] CLAIMS-MADE F] OCCUR 0077924 01 05/07/2014 05/07/2015 OCCUR MED EXP(Any one person) $ 5,000.00 F] PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY ❑ JET ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL❑ AUTOS OWNED ❑ SCHEDULED AUTOS BODILY INJURY(Per accident $ NON-OWNED PROPERTY DAMAGE E] HIRED AUTOS ❑ AUTOS Per accident $ ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑ PER STATUTE ❑EORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIV E.L.EACH ACCIDENT $ 100,000.00 B OFFICERIMEMBEREXCLUDED? NIA 7PJUB2E79058 03/19/2015 03/19/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ 100,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,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 120 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 - AUTHORIZED REPRESENTATIVE �//j��6 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)QF The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs & Business Regulation- Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number Search To search by other fields, enter the search criteria in the fields below and click the 'Search Registrants' button. For the State field, use the two character state abbreviation such as "MA "for Massachusetts and "RI" for Rhode Island. All search fields allow partial text so the search will look for any values that begin with what was entered. For example, if you enter"Fr"in the City/Town field and "MA" in the State field then the search will return records for Framingham, Franklin, and Freetown which all begin with "Fr" and are located in Massachusetts. To return less information enter in more criteria. For instance, entering in a state of "MA" will return a large number of records but entering in a state of "MA" and a city/town of"Medford" will lower the results. Search by Registrant's -- – company's name Search by Registrant's last altif name ------._ — City/Town State Zip code Search Registrants Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Wednesday, April 15, 2015. Search Results REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS NAME INDIVIDUAL NUMBER DATE MEADOWBROOK ALTIF, JOHN 175504 2 REBECCA AVENUE 05/16/2015 Current MOBILE HOME PARK HUDSON, MA 01749 Q2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. _ http://services.oca.state.ma.us/hic/licenseelist.aspx 4/16/2015 Massachusetts -fie part"""yt of Pcc'bhc fet hoard of Buildin 5 R Consrretiegulations and v .� oi)Supervisor tgn and `t'icerrse: CS-099801 „r John T AItif 28 Oakwood Lamer �"�c�rces'ter MA 0t604 %r U N Gohnmissioner ExI�*ratron 02/09/2016 ..