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Home My WebLink AboutBuilding Permit # 6/17/2015 f BUILDINGIT cSORT@{ T THA jo APPLICATION FOR PLAN EXAMINATION ' Permit iVo#: � �/ � Date Received �SsaTED cwus'`�� fi Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION , � Print PROPERTY OWNER iA� -,UryA;u;e— V Printf. 100 Year Structure yes MAP PARCEL ZONING DISTRICHistoric District yest=5 Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Rvvtw Non- Residential El New Building l ❑Addition 11 Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 9 y /// r/ ❑�Wat r � < .Iain// r ell >�S / DESCRIPTION F WORK TO BE PERFORMED: w.. h Identificat' - Please ype or Print Clearly OWNER: Name: �, `" cf. VU Phone: Address: Contractor Name: 4- t Phone: Email: Address: t, A cil 9 .1 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 1 1 -� - � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING fERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ u FEE: $ Check No.: �tol Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to guaranty fund tum AM F NmRT#i TU 11 lit U V C IF 0 N . 16�" 6-o16 T ]� O LAKE h Ver, ass, Ail � c0C g1C"f W8CK �4ATEO S U BOARD OF HEALTH Food/Kitchen r ERMIT Septic System THIS CERTIFIES THAT ............ .. .................. i... ..... ^.....pot.W....... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .. .., ....... .... ............................ ........................... Rough to be occupied as ................ chimney .........��. Ping....+...... ............I I ..... provided that the person accep this permit shall in ry ct 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 ® PERMIT EI ONT S ELECTRICAL INSPECTOR UN LESS C ST CTIO S Rough Service . ..................... . ..... ..... .......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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. Baystate Roofers, Inc. P.O. Box 189 Proposal North Reading, MA 01864 Date Estimate# Tel. 978-664-0668 Fax 978-664-4333 3/13/2015 15821 Name/Address HIC # 137193 Ann Hawley CSSL# 99895 55 Davis St. N.Andovei-01845 Bay State Roofers Inc proposes: Remove approximately 2 100 quare feet of the existing asphalt shingle roof down to the wood decking. Install new ice and water shield along the 6' roof edge, valleys and around all the roof penetrations. Install new 151b felt paper throughout roof area. Install new white aluminum drip edge along the roof perimeter. •new Lifetime GAF Architectural asphalt shingle will be installed over the prepared substrate. •new ridge vent will be installed to ensure the proper roof ventilation. All roof penetrations and flashing will be installed according to manufacturers recommendation, specification and details. Cut and install new lead flashing on the roof chimney. Install new pipe flanges. Bay State Roofers will properly dispose of all roof debris in our own waste containers. Any wood decking that needs replacement will be an additional $2.50 per lineal foot. The garage roof is not included in this proposal. New Shingle Roof Authorized Sig e: Total $7,350.00 Waste containers supplied by Bay State Roofers, Inc. are for sole purpose of roof debris. Under no circumstance is the homeowner to use these containers for personal use. 10 Year Workmanship Warranty on all roofs. (Except Repair Jobs) CONTRACT ACCEPTANCE The specifications,prices,payment schedule are satisfactory and hereby accepted. Date: ZC? BAY STATE ROOFERS,INC.is authorized to perform work as specified. Payment will be made as previously outlined. Signature All bills over 30 days are subject to 1 1/2%finance charge per month(18% annual). Collor The Commonwealth of Massachusetts Department of Industrial Accidents r 1 Congress Street, Suite 100 Boston,MA 02114-2017 .�` www.mass.gov/dia o�Ai S��v Worlcers' Compensation Insurance Affidavit:Builders/ContractorslElectricians/Plum ers. TO BE FILED WITH THE PERMITT)NG AUTHORTT Y. Please Print Le 'bl Aplilicant Information Name (Business/Organization/Individual): Address. v e Phone#: City/State/Zip: Are you an employer?Checic the appropriate box: Type of project(required): em to ees fiill and/or part-time). 7. 0 New'coristruction 1• am a employer with P y 2.0 I am a sole proprietor or partnership and have no employees Working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9, 0 Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repaixs or additions ensure that all contractors either have workers'compensation insurance or are sole 12. plumbing repairs or additions proprietors with no employees, . 5.F1I 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.❑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. t Homeowners who submit 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. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employes•that is providing workers'compensation insurance for my employees. -below is the policy and job site information. ' i C ,kok� Insurance Company Name: LK ExpirationDate: -- Policy#or Self-ins".Lic.#: city/State/Zip- Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152n§h2e f��ofSTOPal violation RI�ORDER and a fine of up to $250.00 a and/or one-year imprisonment,as well as civil Penalties x day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certify under thepains andpenalties of per jury that the information provided alcove is true and,correct. Date: Si ature: Phone#: Official use only. Do not write in this area,to be completed by city or town official. Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Othe r Phone#: Contact Person: nignLIax uz—L 1/ 1`J/ GU 1 J I U : JV ; '1:J HCI pAur. S/ UUq r cLx -)UI YUi AC R& CERTIFICATE OF LIABILITY INSURANCE 1 04.15.2015 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 j AFFORDED BY 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(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 of such endorsement(s). PRODUCER A 8 1,F11INLER INS LLC 'P" I 200 PARC STREET NORTH READING,NIA 01464 ' INSURED BAY STATE ROOFERS INC. Pb is BOX 189 i NORTH READING MAO 1;164 o-r;l Nt�I, 1 COVERAGES CERTIFICATE NUMBER REVISION NUMBER-- THIS UMBERTHIS 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%KITH RESPECT TO VVHICH 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 INSR ADDTYPE OF INSURANCE INSR SUDR POLICY NUMBER MWDDlYYYY MMPOLICY EFF `DO YYYV LIMITS ICY EXP LTR INSR WVD _ I 1 '. GENERAL LIABILITY ��1hir.lF ra(;Ih. ('�NF'12%.. IANI 1' i f3 (iF FN r") AIMS VAU[ .,.,.., 611'JFxPf 1,-.'mp Rx, PEA3C NAL 8 ADv INJURv s ii III 1661`0 A GEN AGC,EGrNTE:UVJ'APILICS^CP P:UUUr. CU�PF .GG t AUTOMOBILE LIABILITY l ;,,+H r•,E r;s r,r,.I:I u.n r rc I 1 1N1 H ;I Pr ,1 jP nI -VU H r -- I v I 'UMBRELLA LIAR1 CIA)k 1 , EXCESSLIAB Icl :r=.r.tA ,. I L<CGATE 5 ' 10ED rte TrJ'aN, ti -- -- { - WORKERS COMPENSATION AND EMPLOYERS'LIABILITY NIA t 1 AC,I r r AW r, $1 000,000 uarrl[ Tal- r . „1[u' N 5562UB X14-122(115 04-1 -201ti ;l+ar]alxy t.NH! L L D,•SCAS_ EA EVPLO'rEE $1 000 000 .1,^2 ❑,�r•P^�r—_:c, 460'1"r-'1)i;2 --=;cka•lolvrr rap:;„,fnash:�r..; � t t ., ._..;t_hr,;.i•.t_IVi' $1 000000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I1 more space Is requlred) I j CERTIFICATE HOLDER CANCELLATION BAYSTATE ROOFERS INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE j P O BOX 189 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NORTH READING MA n 1864 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J 1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD to S`S�,Oy989S c;`JrTa�c Stan�e�e� \ r�GAf o c� �r 0y/29j2��n S 0/41 & - _ - Office Of � �\-_—; • consumer�Affairs s,B MP &B _ � a Re Et ROVErytENTCONTusinessi2egujation �' 4w 9istratio RACTOR EXptratign 137193 BAY STATE 10 11512016 ROOFER TYpe: INC_ Supplement ROBERT OKE PO BOX 189 N.READING, IVIA 01864 Underseereta _� ry