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HomeMy WebLinkAboutBuilding Permit # 5/4/2015 i' NORTH BUILDING PERMIT of �z�en ,bg1O TOWN OF NORTH ANDOVER LICATION FOR PLAN EXAMINATION o LL Permit No#: Date Received arE"o gSSACHUS�� Date Issued: ORTANT: Applicant must complete all items on this page LOCATION � ►`��,I e f �' a Print ` PROPERTY OWNER44 's Print 100 Year Structure yes nno MAP(� PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r ❑ Flood:`lain'r� .,�Wetlands'' ��; �;1Nater'Shed�D;istr�ct �'�Mr imeiix���.�f�vv,�.�.~�✓J.;3s;W�''�.a>t�r�e.r.��;r,-.�/,1St!,''�.�,e,�,wr6,x�,e.r��,,�,ri;c�����.°rr�o✓'.Q`v7/1T.„cra,almrx<yrar"�x„rtr�'i^•,�e;,"1rr171�r r aerrr,a',Ff,u:,n��xrmkz r�r t.,�xtx+.Fr::-:r-w�s�,''"✓�`�j Jnfr'^r=•~ ,.rfli^tr":r.,a �x�:<.%fi�xv::,-Ff,,r��`if��r�s-.r::„-,,�,l."a.F�.�.:str r,r s";�k�`r`nr�ss5'�*-`x.��:"..��"✓,x��r�.�"�i$�..�tr�rr^"� ,r.�-:..�.:�r�{„r":�1�., „z %.,,.��.�, i .�.,,� v..,�. ,�_�s�rx✓f ,,�eu,�f,, r .�. v�''rtrk'� t �,,,.�, .�,�'��r.,rG�, DESCRIPTION OF WORK TO BE PERFORMED: ti dentification- Please T pe or Print Clearly OWNER: Name: cis �� C�'Y0!'( r Phone: { Address: A' Cok)(6 1k”")t Contractor Name: �`� �a, i7 Phone: q °" Yq7 Email: Address: C, Supervisor's Construction License: Exp. Date: Home Improvement License: 1, 7b5--75-- Exp. Date: �Y4111 . 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. c�� Total Project Cost: $ �c'G7 o.. FEE: $ Check No.: II r Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ace ss to u fund - ttORTH -Town -0- 1 over ® ® ® 10030, $I h 1■.� C% TAKE ve l ass, �y COCHICKEwfcK y1' TE 1� u BOARD OF HEALTH Food/Kitchen rwERMITr a Septic System THIS CERTIFIES THAT .................... .... ...... ...... ............................................................................... BUILDING INSPECTOR �® Foundation has permission to erect .......................... buildings on ....... . ........ .1�. . .Ik...... ... . .. ............ �a Rough $o be occupied as . ........... . .. ................. ..... ... .v . ..................................................... Chimney provided that the person accepting th permit shall in every respect c orm 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST TS Rough Service .............. ........ ...... ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to OccupV Bu Rough E Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r allBe Done FIRE DEPARTMENT Until Inspected and Approvede Building Inspector. Burner Street No. Smoke Det. CD Roofing Vincent Colangelo 3 Hodgson St. Tewksbury,Ma 01876 L NEC 2 978-656-8497 ggio 46 6 Fob vincentcolangelo@sbcglobal.net 40 HIC Lic# 170575 CSSL Lic# 105943 ------------------- Customer OWE NS CORNING 3 64A J , (10/Z PREFERRED CONTRACTOR AAA � C Description of work Performed: 0) Obtain required town permits& provide certificates of insurance&workers compensation Provide Dumpster set on planks*for contractors use only(materials all recycled) OKE Attach Large Tarps to protect adjacent finishes, landscaping, and property. I()) Strip-off existing layers of roofing on complete house& re-nail any loose decking (,,Y) Install 8inch I )(, `°° Aluminum Drip edging/Owens Corning Starter Shingles (?),Install Owens Corning Ice&Water shield Eft at eaves, 3ft in valleys, around all penetrations O.,Install Synthetic felt paper to entire roof Install Owens Corning LifeTime warranty TruDefinition Duration shingles (),,Install new neoprene vent pipe flashings on all plumbing pipes (�)'Install Owens Corning VentSure ridge venting with moisture guard o Install Owens Corning ProEdge hip & ridge cap shingles O 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 > 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: Note:This proposal may be withdrawn by us if not accepted within 3 C2 days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT­OF_.THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED­-NOTICE OF CANCELLATION ION 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 el I �-q Work will rl�,,t/begin until your right to cancel has expired and you,have'p_qid' Obool, of dollars ($ unless this agreement provides otherwis6., ,I'Ylo Signature of Contractor or authorized representative`: *(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): As C, The Commonwealth of Massachusetts Department oflndustrialAccidents i d 1 Congress Street,Suite 100 _ .........._.._.._. . . .... ...............................__......�st��;..MA--02II�-201.�..............__....._----..... www.mass.gov/dia �yV Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERNHTTTNG AUTHORITY. A licant Information Please Print Le ibl Name(Business/Organizatiorvindividual): t Address: City/State/Zip: —t1�: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1L0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12. Plumbing repairs or additions 5.p 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.t 14.❑Other- 6,n ther6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 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. I 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 ani an employer that is providing wor kers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: ___-�.c C;14A A e Policy#or Self-ins.Lic.#: lcx Expiration Date: �. � �C S 7 f? City/State/Zip: I`' 'x Job Site Address: A3 i 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 st tement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certlf ze ns a enalties of perjury that the information provided above is true and correct. Si at e: Date: 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: •� LIABILITY INSURANCE FDATE(MM/DINYYYY) 4/23/15 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(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 thi s certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Angela Westen Insurance Agency PONE (978) 735-4094 (AlaFAX No: (978) 735-4095 557 Central Street ADnREss: angela@awesten.com Lowell, MA 01852 INSURERS AFFORDING COVERAGE NAIC# INSURER A:ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP F 0 CONSTRUCTION corporation INSURERC: 119 FARMLAND RD . APT 1 INSURER D: LOWELL, MA 01850 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 BUBB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M/DD/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY L021008696 3/18/15 3/18/16 EACH OCCURRENCE $ 11 00,000 X COMMERCIAL GENERAL LIABILITY DME ETORaENTED re $ 100,000 CLAIMS-MADE F—I OCCUR MED EXP(Ary one person) $ 5 000 PERSONAL&ADV INJURY $ 1,006,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE L IMIT APP LIES PE R PRODUCTS-COMP/OPAGG $ 1 OOO 000 POLICY PRO LOC $ JECTAUTOMOBILE LIABILITY Caacci�FV DtSINGLELIMTT $ ANYAUTO BODILY INJURY(Per person) $ _._. ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIREDAUTOS _AUTOOWNED PROPERTY DAMAGE $ er a caident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 2E112068 3/30/15 3/30/16 WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE 7 N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 kes describe under RIPTIO N OF OPE RATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 104,Additional Rerrarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LARRY AND NANCY HOPP ACCORDANCE WITH THE POLICY PROVISIONS. 16 AVALON ROAD STONEHAM, MA AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: (781) 665-7740 Fax: E-Mail: Office of Consumer Affairs&Business Regulation ME] egistration: 170575 Type: 4, xpiration: )f0/2015 DBA CD ROOFING VINCENT COLANGELO'. 3 HODGSON ST TEWKSBURY,MA 01876 Undersecretary sujwrN i"m SpL-6-010 CSSL-105943 'VINCENT COIANGFLO 3 HOMSMSTREET Tewksbury AfA 01876 03/0912016