HomeMy WebLinkAboutBuilding Permit # 6/17/2015 of NoRrh q
BUILDING PERMIT F�`ryt,t`!o °.a�°
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION +
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Permit NO: , Date Received �
Date Issued:
�9SSgcHus���y
MPORTANT: Applicant must complete all items on this page
LOCATION 1 .,
Paint
PROPERTY OWNER
�- P'rint
MAP NO: tTPARCELs ZONING DISTRICT: �Mistoric District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building YOne family
L Addition E Two or more family Industrial
xAlteration No. of units: I Com rcial
Repair, replacement Assessory B g�� O ers:
L Demolition E Other
Septic I_i Well ❑ Floodplain 1-1 Wetlands Watershed District
D Water/Sewer
-Tns+cL ) ( Vinyl S- J'inq AriN m.x 12 EJ
Single- w tkno,
Identification Please Type or Print Clearly)
OWNER: Name: Ascen Phone:976• 4719 4,a�
Address: MA OS S
CONTRACTOR Name: Phon - 0�1 Z
�i
Address:,
3Z 01 61,Z�
Supervisor's Construction License. Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER NA 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: $ /01000 — FEE: $ 12,0
Check No.: '�A 4'"4-f Receipt No.:
NOTE: Persons contra ting with unregister d contractors do not have access to the uaragv,fund
Signature of Agent/Ovine Signature of contracto
5
ERICAN
RUCT N INS.,.*
4t'rdl�L"s F){;'Y tf.tp,calx,l ri3cSsns 4 >�€lp�i<�,IS1 7
R0 01 1NG(=tDt.NG 'WINDOWS,
f,.i)tF$[@y{3'S.;iezt �9$ft �$t`C'fitE'tltI281..
#. rt¢t€ ,c�J�•. 3 >'(3473tx::ll:l
1 I.0 i<l Fir f4 fmd i+=A 01757
American Construction, Inc.is committed to excellence and quality craftsmanship at an affordable price.
Our success has been achieved by our values:we are professional,detail-oriented, neat,honest,caring
and dependable
Professional Craftsmen.Top Quality Products&Best-in Class Service On it
Customer Names'1f� ' �t k`.` j ) s a 1._;j, Date _ t )
Address,
Town i f 1 s`' 'f". .' t, f f
Phone 1' "<< �1 ;�..� E mar(i f "� f.r:" It o,�" ?�
THIS PROPOSAL IS FOR SIDING REPLACEMENT (over)
-Install new insulation board,
-Wrap all windows with aluminum.
-Install vinyl soffit and aluminum fascia.
-Install all new electrical boxes and water
-Install 18 Sq JMain St Vinyl siding the colorof{ f 1 X (f
.-$ f
15-Year Craftsmanship warranty on installation
CLEAN UP
Cover all sidewalls&landscape with tarps to protect your property including using magnets to pick up all
nails.Covered your grass with tarps and protect plants
MATERIAL&LABOR Total:(10.000.00).,3,,E.
Includes dumpster and permit.
PAYMENT TERMS:
Payments:Deposit $1.000.00 of agreed amount,when half done with balance due on completion&
your satisfaction.
The above prices,specifications and conditions are satisfactory and constitute the entire agreement and
are hereby.
Accepted.You are authorized to perform the work as specified above.Payments will be made as
outlined herein
. j,
Please sign and date.Please make checks payable to AMERICAN CONSTRUCTION ROOFING INC.&mail
to 4 Lucia Or Milford MA 01757
On behalf of AMERICAN CONSTRUCTION ROOFING.,thank you for the opportunity to quote on this
project,we look forward to serving you!,please contact us with any question.At your service
REPRESENTATIVE OF AMERICAN CONSTRUCTION ROOFING INC.508-3710367 Email
luisroofing@hotmail.com
t%ORT H
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. �( -
T C' LAKE h ver, ass,
COCKICHf-CK
�d ADRATED P'Pa���
S V
BOARD OF HEALTH
Food/Kitchen
L �D
Septic System
o
THIS CERTIFIES THAT6 '�" ., ..... ! �. .............................................. BUILDING INSPECTOR
.....ERM21T
.V.... ................ Q Foundation
has permission to erect .......................... buildings on ........I. ...... .�I&" ........ .. ...........
,,ww [ Rough
to be occupied as ................ ... ............ ..,�.l�. .`.....�„�.�!!� !�. ........................ Chimney
provided that the person accepting thi permit shall in a respect conform to a to sof 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 E I ESI 6MOL 1r
NIHS ELECTRICAL INSPECTOR
LESS CONSTRUC T S Rough
Service
............ ... ........ ....... ................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired to Occupy BuildinZ Rough
Islay 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.
The Commojlivealth oflllassachttsetts
Departmew of hidrestrial Accidents
Office of Investigations
600 147asltirtgtotr Street
Bostott., MA 02111
►t',),nv mass.go),1dia
Workeis' Compensation Insurance Affidadt: Builders/C'ontractors/Electricians/Plumbers
Applicant Info><zuaflon Please Print Legibly
Name (Business/otgatuaition/Individual): American Team Construction Inc
Address: 4 Lucia Street
City/State/Zip: Milford, MA 01757 phone 860-753-0452
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with_9 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ [_1 Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working forme in any capacity. workers' comp. insurance. 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their 10. Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.X Other V 1 r)yl
comp. insurance required.]
'Any applicant that checks boa#1 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew aitrdavrt indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I annn an entplol,,er tliat is prot)iding 11,orkers'compensation insurance for nay ernnployees. Below is the policy and job site
hifornnation.
Insurance Company Name: Ace American Insurance Company
Policy#or Self-ins.Lie. #: 8D851692 Expiration Date: 12/07/2015
I Nor/-t 01946-
_92
Job Site Address. P lP�sont S+Me�- City/State/Zi.. dIQVer-, a
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 c. 152 can lead to the imposition of cruuinal 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certif lid e lie pants at penalties of petjuty that the information proJ41 rl above is true and convect.
Signature: {Authorized Agent L__ Date: ZAO 1 _
phd� e—Fax : 860-315- 66 / Cell: 860-753-0452
OrTcial use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
Ar_a CERTIFICATE OF LIABILITY INSURANCE 12:05.24;4
THIS CERTIF;CATE IS ISSUED AS A MATTER OF tNFORMATION ONLY AND C04.>'ERS NO RIGHTS UPON',HE CERTIFICATc -
401-M.. THIS CERT€e[CAT=DOES N'Qi APrIRMAPVELY OR NEGATIVELY AMEND,eXTE40 OR ALTER Tt{c COVERAGE'
AFFORDED FtY THE POLICIES BE:O`N. THIS CERTIFICATE 0"F INSURANCE DOGS NOT CONSTTUTE A CONTRACT BET4 MEN
THE ISSUING!NSURER{S),AUT40RIZI;D Re""PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
s IMPORTANT: It the certitloate holder .ir.ae ADOITIONAL INSURED,the policy{ies)must be endorsed. It SUBROGATION IS WAIVED,
subject to the terms and condhjonb of the policy,ceftain politics may require an endorsement A statement on:his certifrate does
not con'er rights to the certificate holder in llau of Such ondorsoment(st, r
�(UNIVERSAL!NS AGENCY
-738 tO�TSTREET
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COVERACc'$. ----- CERYIEICATc YUr.TBER: ___R_VZSt0N,`1,UjdBE9'
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I r',S'VE `•OR THE POLICY "'ER CO hD A EC STANDING A`Y < rUtR :c 7ER OR OF ANY
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,NS ANCE AID 5 PO C. S D aCRS D HEREN IS S"A C' 1,. A''- 71-IP TEti.Ia. _XC'_ C\_ _.[0
_.•?IFS SHO'NN VAY FAVE SeEN REOUCED BY PAID C_A°<S
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I
�BIiELQAT"c HOLDER ----CA4CcLLATION —
SHOULD ANY O THE ABOVE DESCRIBED POLICIES BEE
:CAWELL"e0 BEFORE THE EXPIRATION GATE '+HEREOF,'
NOTICE WILL DE DELIVERED 14 ACCORDANCE WITH THE!
POLICY?ROVISIONS. _ —
AUTt40R8ED REPRESE.'i'AT;!iE t
ACORD 25 2614'05 ? t988.2C14 ACORD COR?ORA�'ON,All r'9hts reserved,
{ ) he ACORD name and 1090 am,renlstered marks,o'ACORD
"C/)/
)AIce of`(�orlsurrlcr AI'll irs anis Business RC,2jII lIion
f!1 Suitk: 170
f 9c,sW. ;Masstr>r;l'useus 021 1(i
I lonre. Improvcni nt Contractor Rc 6str itii>n
Reylstratil7n: I S I f>7
Tvp«": C;en:-crat�on
AMERICAN TEAM CONSTRUCTION INC.
LOJA LUIS
4 LUCIA ST
MILFORD, MA OP57
I'Pdalo Address and rourn card. for c):m',c.
Addre" Renetcal I:niPlo—woo Loaf Card
CJt1 ee >I(`one _.r \I@nr B.-ne.+ Rr rvl:uu;n 11'ensc r re-isirntinn ealid tor individul use nnh
IMPROVEMENT CONTRACTOR 606f1.c the erlairatian della 11 found I eltfrn to.
�,-e 1 9Y '13C is[rafion:
Type: <7filre ot(:nntielmef 1lfairc and Itu+inrss Rcj!ulnuun
' xpiratlax a .'I;PT
Ccrpornfi,yi Ill P:u'I.Plaza-Suite 517o
[tosl.on.,WX 04116
:;A7 N t.h;TEAM CC?tJS I l 'i;:J Pd MC,
Ll,d........far; `ol valid iihrnli si�_'natury
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Massachusetts -Department of Pisbjsr Safety
e tyd
Board of B:uiding Rcgu;ati„n s and Standards
Y3<1'�ii'itilNx3r�vd2j�t=i tB;fii'
License: CS-097519
LUBOSSVEC
927 THOMPSON ROAD "y
Thompson CT 06277
J �/
Expiration
Commissioner 08/31/2016
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