HomeMy WebLinkAboutBuilding Permit # 6/4/2015 i
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
PermitNO. Date Received
. ry
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION > r�
Prin
O
r� � #
WNER Unit
PROPERTY
Print
MAP NO:Z6J11 PARCEL:_ ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
100 year-old structure yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: El Commercial
CKRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
P jw p
tic Well01111 - '❑�F�loodplaari �, ®Wetlands l ®P%MershedQ stnEti' a
.�: s �•wr'-a,A"r '� ! t x .'`i a s � .r a� p' z :-.�,n- t';t- a v .�
Water/,Sev-erg
DESCRIPTION OF WORK TO BE PERFORMED:
(Identification Please Type or Print Clearly)
OWNER: Name: Ufvdi i Phone: c P 70 -
i ,
Address: / �" Ai✓v
CONTRACTOR Name: �&t Phone:
Address: A s+ (Ai
Supervisor's Construction License: loyy&" Exp. Date: 1 ��
Home Improvement License: d Exp. Date: ��
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
N 4b-2
Total Project Cost: $ U:n _FEE: $
Check No.: �,�✓� s�- Receipt No.: 28'7 W
NOTE: Persons contractin it, unregistered contractors do not have access to the guaranty fund
_ ignature_oficontractor�.
Si nature of;A`gent/Qwner _ __ _
FORTH
Town ofEAndover
® - 0
O
h ver Mass
� o� ��N@ 1.
COCNIC N@WICK V
4ArE E)
ST �T L �D U
BOARD OF HEALTH
ERM� 1 � Food/Kitchen
Septic System
THIS CERTIFIES THAT
KWO BUILDING INSPECTOR
............. .................................................. .�............ ..................
.. ..... ...... ..
" ,a i NNW
Oh
has permission to erect .... buildings on .. ' Foundation
% •• Rough
to be occupied as ................... .... . ..... .. . ... ..... ..... t A l . . . ... .. . ... . ..... ....
Chimney
provided that the person accepting this permit shall in everyres ect conform to th.e.tX.s.of.th.e.ap.p.licat.ion. .
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
PERMITIMONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO S ARTS Rough
Service
.............. .... . ...................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit required t® 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 Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
Offices: !
383(Rear)Lowell Street,Suite 2G
Wakefield,MA 01880 1
PETER RYANr0i
Tel: 617.571.9056and 352 Main Street,Suite 3C
Gloucester,MA 01930
` Inc. Tel: 978-559-7333
` ROOFING, cwww.PeterRyanAndSonRoofing.com
Submitted To: lob Location:
Brenden Murphy
296 Berry Street 296 Berry Street
North Andover,MA North Andover,MA
Phone#: 978-766-7264
Email: None. Proposal Mailed.
Proposal date: May 5,2015
We are pleased to hereby submit this proposal to furnish materials and labor,completely in accordance with the below specifications-
(Additional charges may applyfor any change's not included below,in proposal either by request of olvner•, or if Peter Ryan and Son Roofing finds
unforeseen circumstances that tivill affect the perforinance,quality or integrity of this job).In the event legal action is taken to enforce any provision of
this agreement, theprevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorney's fees. Not responsible
for debris in attic. SGOP� OFWORI�;,
Install vinyl siding: $13,000.00
• Remove existing siding on house
• Prepare existing walls of house for installation of vinyl siding
• Install Tyvek house wrap on entire house
• Install vinyl siding on house
BB Install J-channel to match siding color around all windows and doors,to receive siding
• Install all outside corners to match siding color
• Install white vinyl soffit
• Wrap all soffit,fascia and rakes in coil stock of your choice
Clean Up:
• Will cover area with tarps to minimize debris and remove debris related to work
• NOTE: Please cover any belongings in the attic,as they will get dusty,if applicable
PAYME�TY���1S`
Cost detallS: llucludes"cost of permit,labor,dump&materialPayment Schedule:,,,
1st payment due upon signing: $ 3,000.00
Total COSI: S13SQ0.00 Total balance due upon completion: $10,000.00
Kindly remit payment to"Peter Ryan", Thank lou!
Respectfully Submitted by: - Accepted by: "�A 4��
Our craftsmanship is 100%gua anteed 10-years. AI warrantees are through the manufacturer.All warrantees will be null&void ifjod is n6t paid in full.
Peter Ryan and oofing,Inc.License#178871—Thank you for letting us serve you!!!
cc: Peter/Leo
Vie C'orriuron.wetalth o}filTas,srrch-usett',s
7... DeT:€rr=tntent ofbrthisfrialAceldent:s-
OfT
ire of IrrlxesllTrrtlnrrs
I Congress* Sired, ,S`rrlf�� 1�(l
Boston, H4 02114-2017
''�.���-� ' ll�lt)1t,rrr<rs.s,gr�l�lrlfrr. •
Workers, Compealsl141013 h1s><lnua—ce Affidavit; I�Il l�let'.s/C rr�rti'�r�c��'stEl�rtr'Ici���rSlPi�l�nl)gt s
A ),jHragt Iz f61 AI'tn.t PIe:nseeg,1b.I
��,:�n c$llsinesstarall%ztltiolltktidivic{titil); Peter Ryan and Son Roofing, Inc. F Ca
Add-less; 383[rear) Lowell Street,Suite 20
city/state—/Zip: Wakefield,MA 01880 pliolle #; 617-571-9056
Are yoti an e-ulployel? Check the appropr.iAt:e Bove T)Z7e of l)zroject (l eeltulred):
1.Q 11ii1111 eill)lo er with 4. I tun i �=eiwral colltrulor atict 1
1 Y� � Ej. 1�tew constructiotl
e-1111ligye'es, (full alld/or part-time).'`" have lltl'cd the ,wb-cothvactors
3.[] T full a sole proprietor or partiler- listed on the ntta.ched slleet, 7. []Retllodclillg
Ship ailclhave no rlllployee.s These sell)-owitra:etoii ha�,e S, Deiiiolitioti
tv=orkiilg for 111e in ally capacity. ellrphwtyt's and havc wctrktrs' 9. Btiiildhic, addition
[No workers' coin) , ulstua114e cull)) ill.surance.i
a.t cltlir d,] 5. ❑ we are f wii)orahon ane) its 10.❑ )Electrical re^pni.rs or lidditions
:3. ❑ I frn a llouwotaqi,:r doing till work officcrs 11"we exercised their 11.❑ Plullll ill? repairs or additiow.,
iiiys,df [No workers' c:o.tnp. right of e-xelliption per-MC-IL 12.0 Roof i'epa irs
iilstlrttllct rq uire-cl] t c, 1.62), 5I(4), mid toe hazes tic)
employees, [Noy , orkers` 13.❑ Other
collip,insilrailce i•ecquired]
fflriy 1t>pliGalit IhatGll �k560�.#a 11i0st'also till otnt tlie.wetion belowSIYo1v.Ulg fheiF 11'orkers'compensation policy 01forniation.
1-lomeoiNrnem who submil this affidavit b1dicaling'(11ey lire:etoing all Nvak and then,hire outside contfutom must 5ul)nlit a iiew;affidavit indicating sticti.
ICoatractors thilt check thisbox most iwiched aft the.11ante of file stab-coian,•tctors and,Ante.whe.ther or not those eri(ities have
enli)layees. Iffh:e haw,elliploy"s,they 11111st provide their workers'r_on1p.policy number,
Law all ei)7ployer tlrar4providing wol,ker=s'valiipelrsodort?rrsill'arl,ee fir=rny Beloiv is the policp nrrdjob site
litfo),ni ttoii,
Insurance C 0111pariyNarlie-, N/A (I am not required to carry W.C.as I have no employees)Please see the Sub-Contractor's W,C.01davit attach
Policy ii o1•Self ins. L.iiccj, #/.sRNA E;ph.-itioii Diets:
Jot:)Site Address:.�J`'
Y
Atta:eh a copy of flie workerscoulpens,'tioll pulley dedli'lltfoll pt1gt?(s:llotil=ing the policy utiml)er and esplratlon (late),
Faillare to secture coverage ns reclelwtd-Ualdel Section 25A of MOIL c. 1:52 c.tn lead tel the bill a.sition of oriilliital penalties of n
•fuse tap to $1.50U0,11,1&oi-otie,ycar iilal)ri=}olullel t. tis well as c.kril petlnities iii,elle foa-1ua of n STOP NVORK ORDER mid a fine
of til) to $250,00 a day agattlst thi violator. Be-,idv'ised flint it copy of this stat,riiic It)Tiny 1)r.fo1't�-'arded to the Oftic-e l?f
lnvestigations of the DIA for insurulce cov-era„e-8leri.fwatioli.
I do lr-ere.l)v vv-y f rrauhri,the p(ihvz aild pvv l r lfles of peer tr), til:let the.lrffior'lulu-tlwi pyo)=dr:d rtbai,=e is tr-are awl rolfr ,eel,
_�.....�_...:.... ........,_._... _... .._. ..... .... Stec
Phalle �•� 617.571.9056
a
Ufflc:lal Ilse ntrly, Do-elate tvtfte uta thls criwi, to be coartple-fed&v city w,to gra ttffrz,lttl.
Cit`-or Towne P'er llftlLic.eww #
I5.5idllg.Atrdl:ovity(.kcle olio).
1, Board of Heliltfl '2_,But1ding Departltl:ent 3, Cit-,y/Town Clerk 4. Electrical I1l.5pV.etol' 5,Plttllil)lilg Ins'pectol,
6. Other
Col il:c:t Person; P11011:e:4;.
Pre C;'om.iiaorrther lth of Nlnsrn.clatrseffs
Dep ar•trnent of IrmlarstdralAc oklerafs
x nice vf.Irave.stigaflons,
a 1 C:'vra t e.s.s,S'fr eet, ,Srrlf� 100
Boston, tkL4 02114-20-17
IVIV W.ter(ass,g-0v/thea
Workers' Cotnpensatlon hisunmeeAff1( init; Bnilttet'Slt:antt'£iCtot'slElerhit9r�flslPl.litrtl�E'rs
Ap jlknui I 1for -lotion. P1e:Ezse Prllrt Le. fbhr
Name {$tis€:ressfnrgarrizatiorifindi.victual): Sema Construction, inc.
�4cCtlt`trss: 71 Procpect Street
City/Stiltelzip: Brocktcm, MA 02:301 pjj0lje 4: 508-232-1194
Are you are employer? Check theappropriate box: T)Te of project (r ecltrired):
1.Q 1 1111 n arnptoyer Nvitlr "10 4. FM� I am a.general Contractor. and I
employees(hill mid/or print-them),a` 1mvz hired the sub-contractors 6 ❑Nim.,consti rection
2,El art a.sole proprietor or partner- listed on the attached sheet, 7. ❑ Rentocleliirg
Ship anti have no znrliloyees These sti17-cotitraCtcus have g, F-1 Demolition
working for me in an ca3�a,ci. , zmployees and have wrorkers'
Y ' 1 h' 9. ❑ Building addition
[No workers' comp. ursurauce comp, insurrince.l
required.] 5. We ai•e a mporntion and its 10.7.Electrical rel)111'5 or arklit.iorm,
3.❑ I.am a homeoNvner doing all work officers ha..e:exercised their 11.❑Plumbing repairs or additions
myself. [No workers' 001111), right of exemption per M.CtL 12.0.Roof repairs
insurance required.)t c. 152, §:1(4),and"re have no
employees. [No workers' I: •❑ C)ther
comp, m4tTrance requir'td]
*Aaiy applicant tl:atchecks box#I must.also fill out.the section below showing their workers'couipmsation policy infonuatioa.
I Hoareosimers who submit thisaffidavit indicating they are.doing ail work and then Hire w:tside contractors must submit anew affidavit indicating stach.
tt::ontractors that check this box unist_attactred madditional sheet showing the aaure ofthe sub-r..outractors aud�,tate.whether or not those entities have.
employees. If they mutprovidetheir workers'comp.policy number.
I mit(m empt(�vei,that Isproviding wor'ker's'c•ompensaflott In sumliree far ret,),emploVees, Below is th(I I)olfe)f aged f ob site
lrrforrranttorr,
Instimircz CorripanyNa11w: Insurer A: Northland Insurance, Insurer B: Arbella Protection, Insurer C: Travelers A/R
Polioy#or Self-ins. Lic. 4 6S60UB-5686069-2-15 Expiration Date: 03-01-2016
Job Site Address:
Attach a co 7y of the workers compeirsrttlorr Policy declariltiorr �a e stro`r rr .the :of cS number mid ex 7.frafioir rla.te
1 1 1 1 g ( � Ir 1 )
F,iilure to w-Cure eow.rage is required under Section 2.5A of MCTL c. 15.2 can lead to the irripositiorr cif 4rirrrinml pentahie:s of a
fine up to$1,500,00 arrrcllor ons-seat• imprisorrnrerlt, as well as civil pem.lties in the f mi of a STOP WC)RK ORDER}znd a here
of up to$2.50.00 a clay against the violator. Be advised that a copy of this statement:Wray be fo-€-warded to the OffiQc of
Inve tigations of the DIA for isistunice s(.)Vcwp vt rifreatiom
Irlo horeblf€:ertlf)f rr.Mep the jrn,ltr.rasrr# .f, rr r x• f.�crrfrrily that the tnforutatIm provided above Is5 tme and eormet.
,:i�.l,1 Atli._..---.--�--....r-,..-...�.-�..._-,.._---•.,; ,...�.:.. : .-., _...,.__-..._.,�„-..-.._ �..._._ _.._,�..�._-_..,-.,...--...,_..__,,...,�.._ .--,.,�
Phone9, 508-232-1194 _.,n...m'........, ._...-. ...r_.........,_................_...-...,....M ,..-.,_-..,.-. ....,..r., ._.,r.,.,. . m..... _...-....n-...:_........_m.
Of
flclal ase only, Do trot write ler tiffs(urea, to be completed by clr)f op town official.
CIt.y or Tow'11; Per mitlLic:errse #
ssti:irrb Authority(circle one),
1. Board of Henith :2.B rilclirig DepaiImeut 3. City/Toss'rr Cjer1jr 4,Elec.trienl Inspector 5. 1.'hrrnbing Inspector
6. other
C:o-nta0 Person: Phone#:
���� DATE /YYYY)CERTIFICATE �I �ITINSURANCE 04/09/2015!ll
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 sY 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(los)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 certificate does not confer rights to the
certificate holder In Ileu of such ondorsement u),
PRODUCER GO TACT Jowe M Keller
MossPa Insurapce Seri ces,LLQ ___. _.._._..•_._____........___...__...___.._______.__.._._......
y Wc.No. •—(978)774.4338 x115 I Fax (978)774-1318
o nsuranco.com
27 Garden Street,Unit 1d Mtil• Exit! a mass a (A/G,No):
Damers,MA01923 ADORES$: >o @ P N
INSURERS)MFOROINQ COVERAGE _ NAM H
INSURER A: Norlhland Insurance NOR
INSURED Lema Construction,Inc INSURER B; Arbelia Protection __ 41360
Jesus Lama _ TRAVELERS AIR TRC
71 Prospect Street INSURER C;
BrocHon,MA 02301 INsuRFR D;
INSURER U:
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, T[RM 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,
EXCC051ONS AND CONDITIONS OF SUCH POLICIES,LIMITS_SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _
:NSR D, 5 BR POLICY EFF POLICY EXP LIMITS
LTR TYPE OFTNSURANCF. Wvomm_ POLICYNUMRCR (MM/DO/YYYY)i MAf10D/YYYY —
A GENERAL LIABILITY W8236181 01/3112015 01/31/2016 EACH OCCURRENCE _ s 2,000,0_00
COMMERCIAL GENERAL LIABILITY PDRAMAGE SES 0 a ENTEDenc $ 1001000
occurrCLAIMS•MAOE D OCCUR MED EXP An rs
one peon) _ $ 5,000
PERSONAL&ADV INJURY $ 2,000,000
j GENERAL AGGREGATE s 3,000,000
GENL AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGO $ 3,000,000
J POLICY PRO' LOC S
B AUTOMOBILE LIABILITY 10200097.74 11/2812014 11/28/2015 GEOMaBIN80 S NGLE LIMr1,000,QOO
ANY AUTO BODILY INJURY(Per person) $
ALL OWNEDDULED
✓ AUT
AUTOS BODILY INJURY(Per eccldanl) $
NON•OWNED PROPERTY bAMAGE _.......
V HIRED AUTOS \� AUTOS (Per acciden0 $
UMGRELLA LIAS OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE
DED RETENTION
RETENTION
0 WORKERSCOMPENSATION 6S60U6.5886069.2-15 03/01/26151 03101/2016 � WOSTATLY C14 _
AND EMPLOY ERS'LIABILITY YINLIM Tsag
ANY PROPRIETOR/PARTNEWE,CUTIVIt NIA E.L^EACH ACCIDENT S 500,000
OFFICER/MEMBER EXCLUDED) •—••----
(Mandoloryln NH) E.L.DISEASE•EA EMPLOYEE S 500,600
If as,dasaiba under 500,000
DESCRIPTION OF OPERATIONS below E.L,DISEASE•POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (N tach ACORD 101,Additional Romarks Schedule,If more space Is roquire d)
Proof of Insurance
CERTIFICATE HOLDER CANCELLATION
SHQULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Peter Ryan and Son Roofing,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
383(Rear)Lowell Street ACCORDANCE WITH THE POLICY PROVISIONS,
Sults 2G
Wakefield,MA 01880 AUTHORIZED REPRESENTATIVE /
(D 1988.2010 ACORD CORPORATION, All rights reserved,
ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD
LICENSURE
Lem,a Construction, Inc,
HI'C#; 159106 Jesus Lema
nonarn///r 9f Gl'!/lrupr/ru+<•/h
- gltfcvoCCmuunmaA(1;ilisSBushrtssaiaguinBou fkonsoorregfstrnlionvolitll'urindh•Ititdusoonly Sr,
t I gMEJMPROYEMENT CgN7RACTpR Iwforo tbv oxpirnlinn date, if found return tu;
rt¢a oplslmtlon: 15gy08 Typo Onlce or('onaumer Arroirs ntn]Bnxiness iieguinllon u;
xpiretlon: 313
T/2010 PtNalo Corporalic+ 10 Park PIAm•S,dlo 5110
3 Motion,MA 02114
LEMA CONSTRUCTI`0N:INC.
JF3US LEMA _
71 PRO$PF0T 8T,
HROCK•rox MA 02301 ---r.--- _. -..........................- �..,..-...__..._.
Untinrsra uh,ro' Not vuild Without signaturo
F f 1 alb + .`ia oh,erty
_...__......_........-._._r:f�r'(fi:nrurrrra<,r/1/t
`k•fpven(Cousmuei:rlrfetu fi ISwsluus'RepntaBuu Livensn or rogistriulon valid for Individul use wily
p ME IMPROVEMENT CONTRACTOR. boforo tko.oxlrirntiUn dtrto, li'found ralnrn to+
J UfilccotConsumurAf(wlranndBusinass'ReguMf(a, ��;
oulatralton: -1159100 TYPO' 10 Pork I'hrru•Snito5170 i
' expkallorfl 313112.016 Su IO&Ilt nr<I
PP Boston,61A 02116
LEMA CONSTRUCTION,INC.
JAMES ooiirfRTY
yv.dw. ... r
'lt PROSPECT ST.
BROCKTON,MA 02.301 `---' --—'_^ i -•.. _.. .-_.._....,. ifli �_._.....-. z:;.
Untlro�sacrctary'' 1 �ot valid svltitatl.signnhu•o
LICENSURE
Peter Ryan and Son Roofing,Inc,
HICA:, T7/887l Peter Ryan;
.'('rru„<n<rr.,ra///,,/ r/•rrvrrl,,.+<//s I.Iccnso or rogistrnllon valid for Inilividal use Only •
k�W ()IACt.ofClnntwmcrAlTairvfiUwslw4+svlicgwlnllsm ' tho ush otfnn dow,Tffound return los. pME IMPROVEMENT CONTRACTOR Off1cw ofCousamcr Affilirs anti Busiucss R 511111 "1
ra oplatmlion: 1'18871 Typo' l0 1'n-kPlnxa-Saha5170lxpiration: 0128)2010. Cnrporulion Boston,O1A 02116
PETER RYAN&SON koOFINr3,INC.
Pf.TGR RYAN
303(Rf:AR)LOWEI.I.ST.3VITF 7. Y :y;.✓....�u ff....., ..r .. .
QJAKEFIrLO,IriA 01880 l;ndcrsecrctar) Not vnlld witty t slgnahn'c
r . ., _ -
CS License# CS 10'%8'(5
)fit Massaohusetts-Department of Public Safety
�J Board of Building Regulations and Standards j
COn.rn'urtiun Supervisor �`
License:08.104(}65
11, rill ffff
CLINTON A GATY11V s;
229 Vernon StroW
Wakoffold MA 011*I380
Expiration t;
r CUI1fIT1I3SI0Tlnr 07101/2016 :'
SON FROM C47 to MCD RARTMTo
Y
CQWAWj
7
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