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Home My WebLink AboutBuilding Permit # 6/4/2015 III BUILDING PERMIT TOWN OF NORTH ANDOVER ►. t ,� APPLICATION FOR PLAN EXAMINATION - n ^ ®n Permit NO: Date Received ,w 7 �AATE.0- �y Date Issued: . �SSAC IMPORTANT: Applicant must complete all items on this page f LOCATION .,P rin < 'ROC ERTY OWNER MAR NO: , �,' PARCEL: :; - ZCSNf IVG DLSTRICT: " ;= H�startc;Dtstnct es ; no Y , M TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ffrl�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other a Septic a;Well 1 `Fl77 oodplain `:> O Wetlands Watershed: istirict;< Cj U1lai`�t�l�ew�r c ,�^� '- Identification Please Type or Print Clearly) OWNER: Name; ��r i�r �- Phone: /4' sfA Address: ' °`' °` - � CQ,NTRAGTOR `Name.- : . Phone � ��' :Fz Address Su eruisor's G ns r ; r p o t uct on License exp D,ate:, 0 n 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: $ � �� FEE: $ � Check No.: Receipt No.: 25°-1-1 a NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ignature of contractor- Town of Andover ® . ril v - &.4 14 766 Y' O LAS(@ h ver, MasS9 coc NIc Nlw.cK y1' A04ATe D 0'**0 5 S U BOARD OF HEALTH rER I LD Food/Kitchen Septic System • THIS CERTIFIES THAT ........ �... . ..�''�I BUILDING INSPECTOR .. ....... ........ . .. ................................................. CA Foundation has permission to erect .......................... buildings on .... .. .. .IJ.®.�t. .. ............ . .,............ Rough tobe occupied as ............. ....®. ........... ............... .. ..................................................................... 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST S Rough Service .......... .... .... .... .. .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing Or Dry Wall To Be One FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. ; ._ byLARRY - QUALITY ROOFING ANDSOLA- ;9' 30 Sheridan Street Woburn, MA 01801 owners Name• Owner's address 781.789.9711 CS090389 ems City Owners Zip Code (?rmers Home one Owners ork hone • �� larryhildebrand@verizon.net Project Address Project city Project Zip Code Project Phone Date Quality Roofing by Larry Hildebrand hereinafter referred to as"Contractor",hereby proposes to furnish to Owner all materials and labor necessary to roof and/or improve the above premises in a good,workmanlike and substantial manner according to the following terms,specifications and provisions: a.Description of the work and the materials to be used: New Shingle roofas per the attachment "An project details. New Shingle hoof Total$ 'r! tb ®phonal: Standard Shingle warranty included 10 yr&Lifetime System Plus warranty 20 yr lei Lifetime $240.00 GQWM b.Description of any areas that will NOT be worked on: C.Payment Contractor proposes to This Ifst of specifications may be continued on subsequent pages(see page number below). perform the above work,(subject to any additions and/or deductions pursuant to authorized change orders),for the Total Sum of j , ® Down Payment(if any)1 � _ PAYMENT D rF wuoru —�`-1 AMOUNT PAYMENTS To BE MADE IN INSTALLMENT0 nc FOL nwc 1. Balance upon Completion _ � By check upon receipt of invoice for draws as 2•_y —_ — -- t __- --- described under "Payment Due When" to the left 3. column. 4. d.Commencement and Completion of Work: Substantial commencement of the job shall mean either the physical delivery of materials onto the premises or the Performance of any labor and shall be subject to any permissible delays as per provision(3)on the reverse side of this proposal/contract.. Approximate Start Date; Approximate Completion Date: e.Acceptance:This proposal is approved and accepted.I(we)understand there are no oral agreements or understandings between the parties of this terms,provisions,plans(if any)and specifications in this proposallcontract is the entire agreement between the parties-C agreement The written order only and with the express approval of both parties.Changes may incur additional charges. es in this agreement shall be done by written change Additional Provisions Of This ProposallCContract Are On The Reverse Side And May Be Continued On Notice To Owner on page two(2)before signing.Read"Arbitration of Disputes" Subsequent2),proi Pages(see page number beim,Read provision,if you agree to arbitration,signori the tine bei,,, p provision on page two(a prevision 10 and the NOTICE following this 19 ^�v the,.OTiC€wf;ier indicated.Also,sign in the same place on EACH COPY of this contract. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES You 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 r his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by apMved owner) da telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement See attached Garret Hudlow 'j notice of cancellation for an explanation of this right a10-d(contractor) �dfte- NOTE:This proposal may be withdrawn after 3� days from �> H not approved and signed by both parties. Form RPC-C Copyright 0i 9986-2008 ACT Contractors Forms(800)820-56N www.caffaTm.com Page one of Total Pages The Commonwealth of Massachusetts Print FoIrm Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.►nass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: ////�� City/State/Zip:G�///--..I 10-1-1- Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp. insurance comp. insurance.+ ❑ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]i c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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 arc 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site 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 Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certift and r the )ains and enalties o eer'ur that the in ormation provided above is true and correct. Si nature: Dater /d �� 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 5.Plumbing Inspector 6. Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATEfMMiDDtYYYYI T. IFICATE IS ISSUED ASA 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 BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE O 0 UCER D 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: UNNERSAL INS AGENCY PHONE FAX 374 BELMONT STREET (AIC,No,Ext): (AIC,No): E-MAIL WORCESTER,MA 01604 ADDRESS: 7726B INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY AMERICAN CONSTRUCTION&SIDING INC INSURER 8: INSURER C: INSURER D: 04 SENATE RD APT C INSURER E: MILFORD,MA 01757 INSURER F: COVERAGES CERTIFICATENUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MIMDIYYYY) (MMDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE Is P C COMMERCIAL GENERAL LIABILITY AMAGETO RENTED $ CLAIMS MADE ®OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY F]PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY OMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY S NON OWNED AUTOS (Per accident)PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE Is DEDUCTIBLE RETENTION $ $ A WORKER'S COMPENSA71ON AND XWC STATUTORY FOTHER EMPLOYER'S LIABILITY YM UB-60851692-14 12/07/2014 12167!2015 LIMITS ANY PROPERITORIPARINEWEXECUTIVE M NIA E.L.EACH ACCIDENT $ 100,000 OFFICERM4EM8ER EXCLUDED? (Mandatory In NH) E.L.DISEASE-£A EMPLOYEE $ 100,000 Ityes,desrdbe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT Is 500,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/RESTRICMONWSPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CER7IFICATEHOLDER AFFECTING W ORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION LAWRENCE HILDEBRAND LLC DBA QUALITY ROOFING AND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SOLAR BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILLB DELIV D IN ACCORDANCE WITH THE POLICY PROV 30 SHERIDAN ST AUTHORIZED REPRESENTATIVE WOBURN,MA 01801 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988.2010 ACI n CORP RAA nhts reserved. o�,, � .^�� t +eF�Far ernr^rrv/°1�� /lrr✓,;,;pro°�rr,e�f�!� Office of Consumer Affairs&Business Regulation " t3� �� ME IMPROVEMENT CONTRACTOR egistration: 176769 Type: xpiration: 9/25/2015 LLC LAWRENCE HILDEBRAND,LLC. LAWRENCE HILDEBRAND 30 SHERIDAN STc�.�,� � WOBURN,MA 01801 Undersecretary Massac,,h q ne tt�; Bcmrd c:f I•a ddm l L-rcesuse CS-090389 LAWRENCE HILDEBRAND al 30 SMRIDAN ST WOBURN MA 01801 , V'tWW 05/24/2016