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Home My WebLink AboutBuilding Permit # 5/1/2015 (2) NORTH BUILDING PERMIT 0 TOWN O6F NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 4 Permit No#:— Date Received ArEU nP� t5 S coos Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Y-RW �\V �S� Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no r r Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential - �6- Ll New Building P ne family 0 Addition [I Two or more family 0 Industrial L1 Alteration No. of units: [I Commercial D Repair, replacement El Assessory Bldg [I Others: El Demolition El Other �;�'I��,��}�''�h ,,,1�rr��ry,��r��e,� .V, 'l,f�l1`: , rr �I� „ l��l ODIJN10 # ' 1 DESCRIPTfPN OF WORK TO BE PERFORMED: V, t �Ilc V.. -t Identifcation- Pleas Type or Print learly OWNER: Name: \Vv., �0 lyVK�<--tw\ P h o n e:,.3 6 C- Address: 1ev" 3 lz� if��a—o vyk 9" Contractor Name: 4'A'7 Phone: (r:.A-1 --1 Email: MILIO, Address: IV, (2/�Lzi::: 0— Supervisor's Construction License: 0 5 .3 —Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: :p I NOTE: Persons contracting with unregistered co, tractors do not have Jc'ceTs tothe guaran and 1 071 1; f Ti/ ON wu; 11P I r afU P N RTFj Town of Andover ® 0 No. h ® LAK! ver, Mass, COC NIC Nl wtCK S ll BOARD OF HEALTH Food/Kitchen Septic System ® � }I BUILDING INSPECTOR ...PEROIT . .�.. i�...%..... ..................... ............. .......... ..........THIS CERTIFIES THAT .. ! '� � .�� .......... Foundation has permission to erect .......................... buildings on ...... ... ...... ...... ....................... ....................................................................... Rough to be occupied as .........!� ........ ...� Chimney person accepting"this permit shall in eve respect conform to the terms of the application Final provided that the pe p g p every 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 NTS ELECTRICAL INSPECTOR LESSTI TAR Rough Service ........ ...................................................................... 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. Baystate Roofers,Inc. Proposal P.O. Box 189 North Reading,MA 01864 Date Estimate# Tel. 978-664-0668 Fax 978-664-4333 4/3/2015 15848 Name/Address HIC # 137193 Summit Design Build CSSL# 99895 29 Eames St. North Rerading,MA.01864 Lay State Roofers !no proposes.- Remove roposes:Remove approximately 2500 square feet of the existing asphalt shingle roof down to the wood decking. Install new ice and water shield along the 6' roof edge, valleys and around all the roof penetrations. Install new 4-Sib fc4pape +1,, ,,,811,,,,+, , f�.::�. 6 A A )" Armor G� Install new white aluminum drip edge along the roof perimeter. A new Lifetime GAF Architectural asphalt shingle will be installed over the prepared substrate. A new ridge vent will be installed to ensure the proper roof ventilation. All roof penetrations and flashing will be installed according to manufacturers recommendation, specification and details. Install new pipe flanges. Bay State Roofers will properly dispose of all roof debris in our own waste containers. Any wood decking that needs replacement will be an additional$2.50 per lineal foot. A go over on the shed roof is included in this proposal.The job site is 136 Old Farm Rd.N.Andover,Ma. New Shingle Roof Authorized Signature: Total $8,820.00 Waste containers supplied by Bay State Roofers, Inc. are for sole purpose of roof debris. Under no circumstance is the homeowner to use these containers for personal use. 10 Year Workmanship Warranty on all roofs. (Except Repair Jobs) CONTRACT ACCEPTANCE The specifications,prices,payment schedule are satisfactory and hereby accepted. Date: G l BAY STATE ROOFERS,INC.is authorized to perform work as specified. Payment will be made as previously outlined. Signature All bills over 30 days are subject to 1 1/2%finance charge per month(18% Color annual). - -- The Commonwealth of Massachusetts Department of Industrial Accidents .. I Congress Street,Suite 100 a w tl Boston,MA 02114-2017 www.mass.gov/dia SyOV Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Legibly A licant Information Name(Business/Organizationllndividual): Address: G ryS X1(/ 41/ '' /�j Phone#: ✓� City/State/Zip 1, Are you an employer?Check the appropriate box: Type of project(required): to ees full and/or part-time).* 7. ❑New construction 1.❑ em I am a employer with P Y 2.❑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.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 LQ Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12,.0 plumbing repairs or additions proprietors with no employees. 5,[;J'1"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.Q 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. 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 employer that is providing 4vorkers'compensation insurancefor in employees. Below is the policy and job site information. Insurance Company Name: aG+ I � U 01Expiration Date: Policy#or Self-ins.Lie.#: A City/State/Zip: Job Site Address. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). on e by a fine up to$1,500-00 Failure to secure coverage as t,as required underil penalties in the form of STOP25A is a criminal rWO1RIC ORDERIa d a finef up to$250.00 a and/or one imprisonment,as p 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 certify rrnde' he ns ar 4pe ties gf perjury that the information provided above is true and correct. Date: Si ature: Phone#: l t 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): I.Board of] f Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Massachusetts -De Board of B partment of Public Safety uildio, Peg on.�h'uctioiulations and Standards ) Supervisor License: CS-083853 M'CHAEL S COLIC 29 Eaines Street North ReadIng ATA t7 018iG Commissioner Expiration — ----- 05/20/2016 Office of C onsumer Affairs&B OME t Affairs&Business �r�ac�ecure� egis 'MOVEMENT CONTRACTORegulation 166149 xpiration: 4/29/2016 Type: ,SUMMIT DESIGN Private Corporatic r� BUILD,INC. MICHAEL COUGHLIN, 29 EAMES ST NORTH READING,MA 01864 4�� = Undersecretary y �{