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Home My WebLink AboutBuilding Permit # 6/9/2015 i 7 FORTH BUILDING PERMIT Q��{1FD ,bgtio TOWN OF NORTH ANDOVER �2 h�,.11 16 o APPLICATION FOR PLAN EXAMINATION y _ Permit No#: '-� Date Received SSACHus� Date Issued: k,11-1 ' IMPORTANT: Applicant must complete all items on this page LOCATION C, ' Q � Print / �:z PROPERTY OWNER �) P s+ � IVA (" Print 100 Year Structure yes (1no) MAP v( PARCEL. ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: NKtommercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Se tt� ❑Well 'f r ❑ Floodplain ❑Wetlands ❑ Watershed Distrtctr :uaarc,�"'�Y� YrI ESCRIPTION OF WORK TO BE PERFORMED: �� Identification- lease Type or rint Clearly OWNER: am - Phone: o : l Address: S Contractpr Name: C Phone Email: Address: E ' za Supervisor's Construction License: i0 / q 011__s Exp. Date: Home Improvement License: Exp. Date: `1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 6 FEE: $ Check No.: a Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund town of ( E pr A-ftdover ® t' 1 �o - LAKE h ver, ass, COC KIche WICK �f.9s Rnr�o �Pa��S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �� "�✓ �1� /� C'..... ............................... BUILDING INSPECTOR ...... ...... .... ................................ .................... has permission to erect .......................... buildings on . Foundation � 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 EXPIRESI 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS 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 Approved by the Building Inspector. Burner Street No. Smoke Det. CONTRACT AGREE, made as of the day of AA2015. X. CONTRACTINCC PARTIES Owner: Rc6 West Mill NA LLC; c/o RGc LLC, 17 Ivaloo St, Shite 1.00, Somerville, MA 02143 Trade Subcontractor: Portanova Roofing, Inc, Tax lD#_, �" `J 148 Minot Street, Dorchester, MA 02122 II. PROJECT Roofing Work—Building 3G at One High Street,North. Andover,M01845.(.formej , the Converse,Inc.VlOLId HQ) III. WORK TO BE PERFORMED Supply and install all labor, material, and equipment to perform the following work: Included; Removal of ballast from roof -Removal of rubber from old roof.exposing existing insulation Installation of 1/2" HD plus insulation on top of existing Insolation will be mechanical ly fastened with HD masonry roofing;screws Tally adhered Versico EPDM roof system with 20 yr warranty -New door pan -Copper wall cap with soldered seams 245' of termination bar with copper reglet cut into masonry -Rubber turned up and over parapet walls 8 New Oly-Flow roof drains Dumpsten for roofing debris Permits Excluded: - Masonry work or any structural work - Taking;out door and reinstalling -Any Existing; insulation that has to be replaced -Any carpentry work - Any problems that could conic up relating; to the concrete deck Changes to this Contract increasing;or decreasing the Scope of the Work most be in writing and signed by the Owner and Trade Subcontractor. Page 1/3 IV. COMMENCEMENT AND COMPLETION Date of Commencement: Upon Execution of the Contract Expected Date of Conil5letion: June 30,2015 TIME IS OF THE ESSENCE IN THIS CONTRACT, V. PRICE,and TERMS The.General Contractor shall pay the Trade; Subcontractor the follow i g`an7ount for the Work.included in this Contract: $:199,000 Schedule of payments shall be as follows: $49,750.00 Deposit upon.ftecution of the Contract q $49,750.00 at 50% Complete. • $99,500.00 at 100% Complete, The Trade Subcontractor shall submit an application for payment in the form of an Invoice to the Owner for cacti Payment Due. The Owner, upon inspection mid approval of the completed Work by the Trade Subcontractor, will pay the Trade. Subcontractor the approved Invoice arnount within two weeks of submission of approved Invoice, The Trade.Subcontractor shall submit Partial hien Waivers, in the amount of each progress payment, if any,and a Final hien Waivers upon receipt of the final payment for the Work. All Lien Waivers shall be signed by an authorized representative of the Trade Subcontractor in the presences of a notary public, and so noted. 'I,hc Owner shall not release any payments to the Trade Subcontractor without a signed Lien Waiver. V1. INSURANCE PROVISIONS The Trade Subcontractor shall maintain in effect industry standard Workmen's Compensation Insurance for all of its employees and General Liability Insurance for the duration of the Work of this Contract, No Work shall Commence and no Payments shall be made until a Certificate of Insurance is issued from Trade Subcontractor's Insurance Company npm; ;,ng RCG LLC and RCG West Mill NA LLC as certificate holders and additionally insured, Page 2/3 VII. MANNER of Ext,curION All Work.shall be performed and completed in eomPliance with all federal,.slate,city;and local codes rind ordinances. All Work shall be performed in compliance with OSHA rules and:regulations,All OS14A violations and fines related to the Work of this Contract shall be the respon bility of the Trade Subcontractor performing the Work. All Work shall be performed in a first class workmanlike fashion consistent with the highest standards in the coilstruetion industry AGREED: (]wirer David St4:inbezwh.-tTgei Date , RCG West Mill NA Lf.0 Trade Subcontractor Date Ken Portanova, Portanova Roofing, Inc. Page 3/3 The Commonwealth of Massachusetts F Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia ffidavit:Builders/Contractors/Electr Workers' Compensation Insurance Aicians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORTT'Y. Please Print Le ibl Applicant Information Y Name(Business/Organization/Individual): Ick II �l Address: City/State/Zip: ®` Phone#: Are you an employer?Checic the appropriate box: Type of project(required): 1. I am a employer with-__employees(full and/or part-time).` 7. E]Now construction 2. 1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9, 0 Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. l will 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.[J Plumbing repairs or additions 5.❑I 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.Q 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. Homeowners who submib 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. ffthe sub contractors have employees,they must provide their workers'comp.policy number. X am an employer drat is providingworlcers'compensation insurance for•my employees. Below is the policy and job site information. Insurance Company Name: v rr ff ff n �/ Expiration Date: Policy#or Self-ins.Lic.#: et7 fl 1 1 t "TLa-Q City/State/Zip: /� Job Site Address: [ Attach a copy of the worl er ' compe.sation policy declaration page(showing the policy number and expiry ion 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 WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains ndpenalties o ury that the in ormation provided above is true and correct. o d-® Date: 4;- Siggature: Phone#: official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• r 13 15 01:45p Ann Gallsghet 6173257892 p.1 CERTIFICATE OF LIABILITY INSURANCE DATE(MIVDDNYYY) 03/05/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THEPOLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu ol'such endorsement(s). RODUCER CHE INSURANCE STORE NAI"E: ----...._. .. . ... ---- PHONE (617) 325 - 8952 I FAX *---------- o SPRING STREET �AC,No,E:Iy; j,V,,Ne)_(617) 325 - 7892 E44AIL..... ADDRESS: TEST ROXBURY, 1.% 02132 -- - - INSURER(S)AFFORDING COVERAGENAIL$ INSURERA:WESTERN WORLD INSURANCE COMPANY ISURED 'ORTANOVA ROOFING INC INS URER a:TRAVLERS COMMERCIAL AUTO rNSURERc:TRAVEI,ERS INDEMNITY COMPANY iO Elm Street INSURERD: :ohasset Ma 02025 -- INSURER E: INSURER F: OVERAGES 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, NOTVATH STANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITFF RESPECT TO WHICH THIS CERTIRCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POI(CIES DESCRIBED I EREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'ft TYPE OF INSURANCE INSR L1ND POUCYNUMBER (MMfDDYIYYYY) IM MMDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 COMVERCLALGENEP.AL LIAWLITY PREMISESoccurrence) $ 100,000 CLAIMS-MAD OCCUR ITPPS184359 11/09/14 111/04/15 %IED EXP(Anyone p—on) s 5,000 PERSONAL 8ADI:HJUR`r $ 1,000,000 — GENERAL AGGRE:ATE $ 2,000,000 GENTL AGGREGATE LLMI7 APPLIES PER: i I PRODUCTS-COMP/OPAGG S 2,000,000 JEC POLICY PRO- LOC S AUTOMDBILE LIABILITY Avv.quro iEaoccid-M) - $ 1,000,000 BODILY INJURY(Per person) S ALL OWNED SCHED'AED _ AUTOS X AUTOS BA2D290560 ' BODLY JNJU,RY IPeracddenQ $ X HIREDAUTOS X NON-OWNED PRO cRTY AUTOS 05/06/14 06/05/15 S (Fer ace idem} 100,000 UMBRELLA LIAR OCCUR EACH OCCUP.RENCE E EXCESS UAB CLAIAIS_VlADc ... .—. !AGGREGATE $ OED RETENTION E ... ,— WORKERS COMPENSATION ( C STATU- '0TH- S AND ENIPLGYERS'LTABrL17Y YlN I X TOC STARY TUS ER ANY PROPRIETOR/PARTNERlE3(ECUTIVE 61•M BD807841 10/26/14 110/28/15 EL.EACH AO�IDENr $ OFF ICERiMEMBER EXCLWED7 NIA '.. if Yes, un E.L.DISEASE-EA EMPLOYEE $ )lyes,describe coder '. DESORPTION OFOPERATICNS below j E.L.DISEASE•PO,.CY:,IMi S CRIPTION OF OPERATIONS)LOCATIONS!VEHICLES(AHach ACORD 101,Additional Remarks a'chedula,IT more space is required) OFING & CARPENTRY 2TIFICATE HOLDER CANCELLATION ilding Department ty of North .Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED rN 00 Osgood streety Bldg 20 Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. rth Andover Ma 01845 AUTHORIZED REpRESENiAT1VE {1� 1988-2010 ACORD CORPORATION. All rights reserved, )RD 26(2010(051 The ACORD name and logo are registered marks of ACORD ' CJ�G �IJ6'/)7/I720421(18G.LfcL 0��1(cJJ((C7t clJC'�f[ ', Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR WeiSt gration: j78521 Type: piration: - .4/23/2016 Private Corporatio, PORTANOVA ROOFING INC. i KENNETH PORTANOVA 148 MINOT STREET DORCHESTER,MA 02122 Undersecretary f .._. - .t } � r5 kit i s Cs 167403 V., "NNBTI-I PORTAI�OVA 14RMIROT ST AST 1 Dorchester NfA 0122 .• I ��`� n 141 t� � a t��It2tii>r1 9 06/2112017 C;�I71j1"1 SSldrl ..,