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Home My WebLink AboutBuilding Permit # 4/21/2015 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION - y Permit NO: Date Received- AT �9SSAcwus��R`' Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER fJt j Print, MAP NO: PARCEQL�11 DISTRICT: Historic District yes no Machine Shop Village yes no I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building rie family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial DJk"epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: C ) Phone: 121- S d7...- i Address: CONTRACTOR Name: Phone: 2f ko Address. Supervisor's Construction License: Exp. Date: (oi qL Home Improvement License: / Exp. Date: 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: $ t `r �ou FEE: $ Check No.: z <` 5� Receipt No.: ' 'L5' - NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner a-Cg Signature of contractor NORTH Town of Andover No. h " ver, KSS, `I l t 421 , 47 � o C0CK1c"t-1CK y1. X9,9 AOJATeo S U BOARD OF HEALTH PERMIT T LU Food/Kitchen Septic System THIS CERTIFIES THAT ...................... BUILDING INSPECTOR ..... tic} . ................ ............ '>i FM..jkW � ,. � ..... Foundation has permission to erect.......................... buildings on52W® Rough tobe occupied as ...� „ ......., Tvf ........................................................................ Chimney. provided that the person accepti this permit shall in every respect conform to the terms of the application Final p 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS C STR C STARTS Rough ............................... Service ......... ..... 1t. .. . .r,.r�...... 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. GONG KrN 0 ,°� Craig LaCrosse-Owner • Contract 978-580-7376 April 6, 2015 craig@roofingkinginc.com Customer: Lou Wagner Address: 32 Equestrian Drive, North Andover Postal Code: 01845 Phone: 978-807-6657 Fax: Email: wagnerlj®comcast.net Thank you for allowing Roofing King Inc. the opportunity to work with you. Here is a list of the work to be completed, the agreed price and payment structure. Please feet free to contact me with any questions or concerns at the number listed above. SCOPE OF WORK: Full roof replacement - House wilt be covered with roofing blankets to prevent any damage and for easy cleanup -Remove all shingles right down to existing wood and re-nail and prep before installation process begins -Install up to 96sq ft of rotted plywood (3 sheets 1/2 roof plywood)at no charge on any full roof replacement Ft $50 per additional sheet if needed -Install 6 ft of GAF Storm Guard ice and water shield teak barrier along base of roof and areas listed below -Cover all valleys 8t snow load areas, wrap all penetrations including but not limited to chimney's and sky lights -Remove and re-install new plumbing flashing on soil pipes vented through the roof -Install Rhino Liner on any exposed wood before shingles are applied -Install new 8 " (color)drip edge on all edges of roof for proper protection -Install GAF Pro Start starter strips around entire perimeter of the roof to create a 1/2 inch overhang for proper install -Install GAF Architectural Timberline HD LIFETIME Ltd. Shingles will be storm nailed with 6 nails per shingle 130 MPH resistance -Cut 1 1/2 inch opening on peak of roof if it wasn't previously done for proper installation to meet building code (on full replacements) -Remove old lead around chimney and reinstall 12 inch lead and reseal joints(if applicable) -Install Cobra exhaust vent on peak of roof to allow proper ventilation and meet building code -Hand nail Seal A. Ridge caps on peak of roof with 2 inch nails to complete installation. -Blow off entire roof, driveway and all walking surfaces and clean any loose nails with 3 ft rolling magnets daily or on completion -Existing roof will be removed and recycled at Roof Top Recycling (Certified Green Roofer) Optional Upgrades (on full roof replacements) -Deck Armor in place of Rhino liner $200.00 Included -Timber-Tex Caps in place of Seal-A-Ridge Caps $200.00 included -Weather watch upgraded to Storm Guard Ice and Water Shield $0.00 Included - Replace skylights(2 skylights at$600 each) $1,2010 Included -Replace 2 skylights at$600 each $1,200 Included WarrantK Roof comes with 50 Year Weather Stopper Pius LTD manufactures warranty Promotions Military,Veterans and Retirees receive a$250 Rebate through GAF when purchasing a GAF Lifetime Roofing`tSystem. PAYMENT STRUCTURE; This price includes labor,material,trash removal and building permit if required and contract may act a.,signature for permit. (Any additional work will require separate pricing) Make all checks payable to Roofing King Inc Total: $16,100.00-$500 Act Fast Coupon(Exp.3131) $15',600.00 Deposit(due at signing): (113) $5,:00.00 2"d Payment(due when material is onsite): $0.00 Final payment(due upon job completion): (213`) x$10,400.00 Owner/Contractor Property dwner Craig LaCrosse Lou Wagner The Commonwealth of Massachusetts Department of Inc! trial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov1dia ors/Electricians/Plum hers. Workers'CompellsatiOu insurance Affidavit:Builders/Contract TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print LVibil I ti fr -tin Name (Business/organization/Individual): Address: I a VY-\a we-co 3� -7 3 ,, City/State/Zip: `�-q(A M(� C))g Z9 Phone#: 7S- S go' Type of project(required): Are you an employer? k the appropriate $: 7. 0 New construction I.Ej I am a employer with ___employces(full and/or art-time).° 2.01 am a sole proprietor or partnership and have no employees working forme in S. [J Remodeling any capacity.[No workers'comp.insurance required 1 9. ❑Demolition 3.01 am a homeowner doing all work myself[No workers'comp.insuranee,required.)r 10 Building addition 4.[]l am a homeowner and will be hiring contractors to conduct all work on my property I will 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance of ate SOIC pr prietors with no employees. 12-DPlumbing repairs or additions S. I am a general contractor and I have hired the sub-contractors listed on the attached sheet- 13.[.-JR6of repairs These sub-contractors have employees and have workers'comp.insurance.: 14.E]Other - 6.E]We are a corporation and its officers have exercised their right ofexemPtion Per MOL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box M I must also fill out the section below showing their workers'compensation policy information. t 140meowners who submit this affidavit indicating they are doing all work and then hire outside contractors intiSt submit a new affidavit indicating such. tConuadors 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. workers'co insurance M,employees. Below is the policy and Job site I am an employer that is providing information. Insurance Company Name:_ Policy#or Self-ins.Lic. Expiration Date:_ Job Site Address: 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. I do hereby M certify u&the pains far"pe ties of perjury that she information provided above is true and correct. Si re: Date: Phonic M. 6.Eofficial use only. Do not write In this area,to be completed by city or town official official Use only. Permit/License V City or Town: Luing Authority(circle one): ss I Building 1.Board of Health, 2.Building Department 3.City/Town Clerk, 4,Electrical Inspector 5.Plumbing Inspector Gther Co t ,P Phone#: Contact Person:- Ufi�!rr r;f( tHt1t!(ii�r RtVat�& x egiWatlOia: WAX e -.•.�+ 12 MALVERN s� s0 - 2!jAnVERN AQ Aw a � r 1 HA a /�' CERTIFICATE LIABILITY DATE` YYY) 3/13/2015 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 TIME COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: N the ceroficate holder Is an ADDITIONAL INSURED, )must be endorsed If SUBROGATION IS WAIVED, the terms and conditions of the policy,certain policies may require an endorsement A statement on thk certificate does not confer rights to the certificate holder In lieu of such endorserneS). PRODUCER Melissa Warren Risk Strategies Company . (781)986-400 (781)963-@4a0 15 Pacella Park Drive Suite 240 IN!0M,5)AFFORDING COVERAGE NAIC0 Randolph MA 02368 IN A:Scottsdale insurance Co INSURED wsuRER B:Guard Insurance Group .junior T P Construction INSURER c: 406 Bridge Street INSURER D: #3 IH E; !Lowell MA 01850 RF: COVERAGES CERTIFICATE NUMBER.CL1531391061 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE 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. w= PAAA- POLICY EFF PMJCY EXP Am TYPE OF INSURANCE wM GENERALLIASILRY EACH OCCURRENCE S 1,000,000 $ COMMERCIAL GENERAL LIABILITYE Ea 8 100,000 AGtAiMS-tabADE �OGCUR P81914893 /11/2015 /11/2016 MED EXP( One e!rao2) _ S 5,000 PERSONAJ.&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X I POLICY PRO LOC $ A _ ANY AUTO BODILY INJURY(Per u ) S '... ALL OWNED SCHEDULED BODILY INJURY(Per ) $ AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS 1per accident) $ UfNeRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESSLIAa CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ S STATU DTH H AND WORKERS COhIPENSATION YEW LIAfR1ITY ANY PROPRIETORIPARTNERIEXECUTIVE YI-�j NIA a E.L-EACH ACCIDENT S 100,000 OFFICER R EXCLUDED? L�J 2 527411 /11/2013 /11/2016 pandatm e"") E DISEASE-EA EMPLOYEd S 100,000 If yy��daegibe under OF OPERATIONS below E.L.DISEASE-POLICY UMiT 8500,000 DEfiGIRIPTION OF OPEPATIONS I LOCATIONStVEHICLES(Attach ACORD 101,Additional Marawsw Schadute,U mom space is requfted) Evidence of insurance CERTIFICATE.HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AFORE THE EXPIRATION DATE THEREOF. NOTICE ALL BE DELIVERED IN Roofing Ring, Inc. ACCORDANCE WITH THE POUCY PROVISIONS. 12 Malvern Avenue Tyngsbroro, KA 01879 AUTHORMED REPRESENTATIVE Kichael Christian/MSG ACORD 25(20i0=) @ 1"8-2010 ACORD CORPORATION. AH rights reserVed. INS025(2oiomyo1 The ACORD name and logo are registered morks of ACORD DATE(M ) AC7COR00 CERTIFICATE2/12/201 ERTIFIC TE THISCER CERTIFICATE IS ISSUED R A TY OR NEGATIVELY AMENDR OF INFORMATION ,EXTEND OR ALTER AND CONFERS NO RT'GHTS UPON THE C HE COVERAGE AFFORDEDABY THEPOLICIES CERTIFICATE DOES NOT AFFIRMATIVELY O 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 illi an A L INSURED, the policy( ) e . If SUBROGATION!S 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 endorsements). PRODUCER -- FAX McSweeney&Ricci Insurance Agency, Inc. _RE ( N--L7-81 3= 07 - - 20 Washin n Street pDDRESg.mrir�PD ionCo7mcsweerlevncCl corTl _____--- --- P.O.Box 8 INSUREND AFFORDING COVERAGE Braintree MA 02185 ---_ -_-- INsurc�� C�Q.--- ------- ---- ---- - --------- 78�- INSURED ROOFK-1 INsuRgRe Rooting King Inc INSv�R c:StallD�[aL►��Comlaany---- --._.-_ ----------- Craig LaCrosse �NsuRER D-Qtain ecialty Jn ila[ao.s (alnR_ --- — 12 Malvern Ave INSURER E: _ Tyngsboro MA 01879 _------ ----. -------- -- <l4SU F COVERAGES CERTIFICATE NUMBER.11169 31 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 ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITI 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 SH MAY HAVE BEEN REDUCED BY PAID CLAIMS.AWL POLVd:Y EFF EXP ----- ----.— _.----...—--- --- LIMITS POL+CY TYPE OF INSURANCE ( POLICY NUMVR GENERAL LIABILITY Y Y CGL 0059562-21 ?111/2014 2/91/2015 EACH OCCURRENCE $9000000 D CIP229932 /28/2015 /2812015 $100004 X PREMISES(Ea Nocanrencsc� --__ COMMERCIAL GENERAL LIABILITY $5,000 &MADE r OCCUR PERSO f S + _MED CLAIM _ - - � t fdAL&-A DV IN.ft1R"/ I$1 GEP1In.RAL AGGREGATE $2404000 -- G£NLAGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $2000000 ---- PRO- $ POLIGY LOC B AUTO LELUU3WTY �Y MIT5776F X312012014 fM2015 /Ea-a awl--..__ 1-000-090-- B 00O<X! ---- - -- i BODILY INJURY(Pear per$W) $ ANY AUTO I ! ------------ ----._.-----__ BOpILY INJt1RY(P�ecatfe+tit) $ ALL OWNED X SCHEDULED ------ AUTOS AUTOS PROPERTY DAMAGE $ NON-OVMED Per acdd�_ -------------- X HIRED AUTOS X AUTOS $ A U IA UAB OCCUR CU0071022 2(11!2414 17111(2415 EACH OCCURRENCE --- $2000000___---_—---- EXCESS LU4B CLAIMS-MADE AGGREGATE _ - $2.000,000 $ DED RETENTION$ WC STATU- I Dl"- C WORKERS C SATION I i WC0742797 i/20!2014 20/2015 — T 4lFAITS.I. AND EMPLOYERS'LABILITY YIN � _ ANY PROPRIETORRARTNER/EXECUT VEt�-�--�� i '� E-L.EACH ACCIDENT S 500400 OFF[ EXCLUDED? L::_J NFA 1 + �E L.DISEASE-FR F�APLOYE $50,040 -- (Mandatory In NH) —---_._ If yS desobe under E.L.DISEASE-POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS below ( t DESCRIPTION OF OPERATK)NS/LOCATIONS I VEMLES(Attach ACORO 101, nal R If re to I Roofing(commercial and residential),siding and snow removal services CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE.ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE: THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Roofing King Inc ACCORDANCE WITH THE POLICY PROVISIONS. 12 Malvern Ave Tyngsboro PAA 01879 AUTHOFUZED REPRESENTATIVE 1 2010 ACORD CORPORATION. All rights reserved. ACORD 25(20101`05) The ACORD naive and logo are registered marks of ACORD