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HomeMy WebLinkAboutBuilding Permit # 6/4/2015 TOWN OF NORTH ANDOVERAPPLICATION FOR FOR PLAN EXAMINATION Permit NO: Date Received °� —JUN".wK 6h0AT8°APp'.c Date Issued: ENHORTANT: Applicant must complete all items on this pae LOCATION ICtt PROPER`C1! OWNER � I 4;11111 MAPNOS PAR L, ©KING DkTRICT _�1-�askorl7�strlk yid ri �� Shy `Vill( hca.. 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 ❑ Saptie ` �1 Wefl ❑ Floodplain O; rshed District q lNater/ ewr ; `. AIdentification Please Type or Print Clearly) OWNER: Name: t c:=� 'iCT-4\--\QAzZ i Phone: Address: Q " - „.�-\ � �✓ r �CONTRACT( R Name Phone.; Address{ g vW IlY C.i Wrw4 , . Supervisor's Construction Licens77- e,' Exp `Date Home lm . 6ment License 'ExpDate 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: $ "i 0 FEE: $ A u Check No.: ' 22`x--9 Receipt No.: t1 OTE: Persons contracting with unre istered contractors do not have access to the guaranty fund F e. 1l Signature of Agent `/Owne Signature of contract NORTFf own of Andover o ii., " m No. " hver,Mass, (� �.9 BORATE„ I.PP�`,gJ S oU BOARD OF HEALTH P E IL D Food/Kitchen ey a Septic system THIS CERTIFIES THAT........ .. ... . ..®............ Gam?;.t, BUILDING INSPECTOR I Foundation has permission to erect..........................buildings on.'.. .....I. to be occupied as....... .... .. . ........ .... ... .. h m Rn�n ey provided that the person acce i this permit shall in every respect nform 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TA S Rnngh Sn �e .................. .. ..... .............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rnngh Display in a Conspicuous Place on the Premises a 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. smni«Det. ` The Cottunonweaith of Massaehuselts !1 _ Department of Industrial Aceidents 1 Congress Street,Suite 100 � ��� Boston,MA 02114-1017 "W � www.massgov/dia R`orkers'Compensation Insurance Affidavit:Builders/ContrasCors/Electticians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Applicant Information Please Print Le bi Name(Busmess/Oreammtoa/lndh ideal):Duval Roofing LLC Address:P.O.Box 637 City/State/Zip;North Reading,MA 01864 Phone#:978-664-2557 Are you an employee?Chakthoapp p,bAc bos: Type of project(required): 1.❑✓Ism a employ—ch$ employees(frill and/or Parttime),` 7.❑New construction 2❑iavrasola proprietor or partnership and have vo employees working forvrem 8_nRemodeling env capaciry.[No workers'—s,i¢sumnce mquved.] 9. Demolition 3�I am ahomeoamei doing all work myself.[No workers'cop.irrsmanca ragwred.]t contracrom 4.❑lamahomeownerandwillbeh b con duet all work ovm properI,,U 10 E]Building addition g y ty. as wewat an oonaaorors aithar have workers oompensaoo,r inawanoe or are sole 11.QElactrical repairs or additions pmpdntors with no employees. 12.❑Plumbing repairs or additions 5❑tame general oonvmatorand l have hi olTcsvbeonuactors tiered on the? cbattached shoes 13.�Roof repairs These sroovua—,kava employees and have workers'comp.ivsurericc 6.0 Weamacorporetion and im officers have caer—d their right of axe prion p—MG1, 14. Other 152,§1(4),and we haveno eployeas.[No workers'Damp.horr.a raquvedl 'Any applicant that chocks Mx kl must oleo fill out Ne scotlon below showing their worti rs'compaysatiov policy information 'Homeowners who submit this affidavit inmcatmg they are doing ah work and then biro outside oovnaotors mun submit a newaffi-1 indicating svah. tCovnactors that aback this bos mum attached an additional sheet showing the name of the svbaonvaotors arW state whether or not those-uties have ccrrLyaos.if the sub-conn '—have avrployecx,they ann provide their workers comp policy¢umber. lam an employer that is provi&ng workers'compensation insurance for my employees.Below is the policy andjob site information. Insurance Company Name:Travelers Polio #or Self-ins.Lic.#:7PJUB-023ON91-9-15 E 3/9116 Policy Expiration Date' Job Site Address:1589 Salem Street City/State/Zip:No Andover ma Attach a copy ofthe 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi der thepains and penalties ofpe jurythat thein ormathm provided ab ore A true and correct sienamr� f^ Date _€ s5 Phone#:978-664-2557 Official use only.Do not write in this area,to be completed by city or two official. City or Town: Permit/License# Issuing Authority(circle ane): 1.Boned of Health 2.Building Department 3.City/'Pown Clark 4.E!ec;ical T-loccte,5,Plumbing Inspect., 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE 3/12/2015.) 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 THE COVERAGE AFFORDED By THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORRED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(iss)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 cedificate does not confer rights to the certificate holder in lieu of such endorsement(-). CONT _EACT Barbara McDonough Gilbert Insurance Agency, Inc. 81)942-2225 .(Ts1)942-2226 137 Main Street .bmed(]oaougb@gilbertiasuraacBAcom Reading MA 01867-3922 RA 1[arle50sVille/Nationwide 26182# u RB:P1 oath Rock Assurance Co 004154 Duval Roofing, LLC. INSURERC:Travelers Ins. Co. 031 P.O. Box 637 Korth Reading MA 01864 I.—En I COVERAGES CIRTIFICATENUMBERCL3411601329REVISION 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. GENERALN1111-1 POLICYErr POLICY UBT TYPE °ABLrry as 1,000,000 % oo oE®oCR 0/ 5,000Amn ,000,0(0100,000 A 1 lHlIJRY S. 2,000,000 O R. c 5 2,000,000 %NPo AUTIIIIILELIABIUTY 500 000 B RY(Per lwrmn) 5 D % A RC00001003]99 0/23/201410/23/2015 a RY(Per accitleM)E % H DART % A Toa ° rac 100,000 eDGUA LUB n s s a C sRS`OABIUTY ANO EMPLOY cwo DTIVEO N 8-0230N91-9-19 S 100,000 an Ii xnj Ex /11/2015 /11/2016 E s 100,00 500,00 Evidence o£ECoverage AHIIIIIEHicLM AD—Ac°RD)O1,Aemtiona)nemarwsscneaule,umare spam is require) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. Al"OSIZED REPRESENTATIVE M Gilbert, CIC/BARBAR GL�1 � Jl e � �Uli�rtnr� , 4vl ii �Lk !n Fx G a�z a RUM (¢�ypirraczatrcitcx���-r,��C��lr/�xl�txc�erilt�✓y�- h Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 167336 Type: LLC DUVAL ROOFING LLC. Expiration: 9/10/2016 Tr#256221 KENNETH DUVAL _ - -- P.O.BOX 637 — — NO.READING,MA 01864 Update Address m d" turn card.M k Basan for change. eMe, D Address Erapiq,—t ❑i'.C.rd Page No. of Pages Jty_ tt]a Builders License l 58443 Home Construction Reg.t 1.67338 DuvalAiL (781)944-1994 (978)664-2557 READING NORTH READING P.O.Box 637,North Reading,MA 01864 please visit us at Www-duvalroofing.com so �nIE s - - c,sraxEana ia000s Wefi by subm[spepR rid estimates tor. ❑Rip&Remove ail existing roof related debris#ram roof as well as job site with ourown disposal truck.NO DRIVEWAY DUMPSTERS Ll 1 layer of existing roof shingles U2 layers of existing roof shingles Q 3 layers.or more of existing roof shingles. Ll Replace any damaged roof decking;not to exceed 82sq.R.(additional at$1.70 per sq:It). L.1 Install 8-Aluminum Drip-edge/Rake-edge along entire perimeter(Choice of White,Brown or Mill) LI install ICE&WATER UNDERLAVMENT on all horizontal eaves,sidewatis,skylights,chimney(lashing and valley areas Q'Install a premium base sheet underlayment(Pelt)that is in compacoe with the asphalt shingle manufacturer chosen by he homeowner L31nstall The Homeowners Choice of the selected Tamko/IKO-or GAF Limited Lifetime Architectural Roof Shingles `See individual manufacturers warranty for specific details or please call us with any questions Li Replace all existing bathroom louver and/or exhaust Ppe(s)with new aluminum.flanges P3 Chimneyts)-counter-flash.and re-step existing flashing. LI Cut&Install new lead flashing Q Install a continuous low profile Ridge-Vent on all ridgefines Z-Soffit-Vents ❑Roof Louver-Vents O Seamless Aluminum Gutters-Custom fabricated on site with our awn gutter machine J Downspouts at additional Ll Leaf Guards Q Other ❑R ft: lation Increase existing R,vaiueto R.value 3Fx IJ—Pose hereby to furnish material and labor-complete in accordance with above specifications,far the sum of: _ - Notal price of including options.dollars(3. 1. Paymentd be made as follows: 309-e.deposit required beforeordering materials..Balance due in full upon day Of Completion. Please makeall payments out to Kenneth Duval,mailed to;P.O.Box 637.No.Reading,MA 01864 Final Payment is due upon day of completion and is subject to the Authorized _ supplemented Tens&Condfion sheet when scheduling. Signature -THIS PROPOSAL IS VALID FOR DAYS DUE TO - FLUCTUATIONS IN MATERIAL&DISPOSAL PRICES. -r