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HomeMy WebLinkAboutBuilding Permit # 6/29/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Priq PROPERTY OWNER 37letki 2,>6 J7 Print MAP NO: PARCEL:-� ZONING DISTRICT: Historic District yes ➢ Machine Shop Village yes d" 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 D Septic D Well ❑Floodplain [] Wetlands ❑`Watershed District ❑Water/ScvTer DESCRIPTION OF—WORK TQ,,-3E PER17O_IMrD: dIdentification Please Type or Print Clearly) OWNER: Name: / d`1 �, Phone: Address: /lei 124° CONTRACTOR Name: zol ?�' Phone: Address: ef J Supervisor's Construction License: / Exp. Date: r' Home Improvement License: 06)'/6 Exp. Date: 910/1 r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ; FEE: $ 1 Check No.: / Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund — — - --- - - - - ,Signature of Agent/Owner SJgpature_of'contractor F FORTH Town of It IT,, ndover 021�O LAKE h ver, Mass, coc"Ic"tw", 0"?ArED C5 S U BOARD OF HEALTH Food/Kitchen E R Septic System RTHIS CERTIFIES THATT T D 010 g'� BUILDING INSPECTOR ..................... ...................... ..........................�... ........ ............................ has permission to erect buildings on Foundation ... ... ... . . .. Rough tobe occupied as ........ ...... ........... ...... ..... ..............................................................................rot; 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 PERMIT EXIES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough .....:. Service ............ ... .................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy 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. ESTABLISHED 1985 PROPOSAt DATE OF PROPOSAL 8!2112 15 www.expressroofer.com l,ikwl a(geaxyrercesfraAna HOME IMPROVEMENT CONTRACTORS LICENSE#108126 P.O.Box 542,Chelmsford,MA 41824 CONSTRUCTION SUPERVISOR LICENCE#99497 Phone:978.256.23331 Fax:978.251-2947 0,0 4 WORK TO BE PERFORMED AT: r� Ji U %a y 21 We hereby propose to furnish materials and perform the labor necessary for the completion of., STRIP UP TO 1 LAYER OF ASPHALT SHINGLES OFF HOUSE-WINDOW-GARAGE ROOFS CLEAN UP AND HAUL AWAY TARP OFF HOUSE TO HELP PREVENT DAMAGE TO HOUSE AND LAWN AREA COMPLETELY DE-NAIL OLD ROOFING NAILS AND RE- AIL ROOFING BOARDS AS NEEDED WITH 85 RING SHANK NAILS ALL WALL FLASHING W ILL BE INSPECTED AND REPLACED AS NEEDED Install: IKO Storm Shield 6'up from the bottom eaves IKO Storm Shield under chi'mne lead and 3'down on roof IKO Storm Shield in valleys Felt paper over roof boards IKO Storm Shield 3'on roof where roof buts into walls IKO Leading Edge Plus Starter strip on all roof decking edges IKO Cambridge Architectural shingles We install 6 nails er shingle for a 130 mph IKO wind warrant Cut in 1 1/2"opening on peak o roo and install Raof aver rid event alon all rid esu aces All rid event is Hand Nailed IKO ridge cap shingles 8"Drie ed a on all outside roof ed es white All shingles will be fastened usin 1 '/."-1 '2'roofing nails BLOW OFF ENTIRE ROOF AND CLEAN GUTTERS AND DOWNSPOUTS ROLL 3 FOOT MAGNETS OUT TO PICK NAILS OFF LAWN AREA FOR FINAL CIE—A—N-015— INCLUDES,,ALL LABOAND MATERIALS FOR'"THE ABCWE AND ROOFING PERIpBIT ALL ROOFING MATERIALS STRIPPED OFF YOUR ROOF WILL BE RECYCLED AT ROOFTOP RECYCLING 15 YEAR ORK A ISHIP LIMn ED AND A LIMITED LIFE TIME IKO SHINGLE WARRANTY ANTY CLEAN UP AND HAUL AWAY ALL SHINGLES Note:No warranty on problems and/or damaged caused by ice backups No warranty on old skylights All material is guaranteed to be as specified,and the work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of., $12,394.00 $NO NEYDOWN PAYMENT.IN FULL AT COMPLETION OF JOB WITH P< a=621& 0.t`4E4k NAME OUT IN THE NAME OF Ert resss Roofing INC. Call Toll Free Respectfully submitted Y.,- 1-888„21 O-ROOF Note-This proposal maybe Wthdrawn by us if not accepted by. 6/2512015 All workers fully insure ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above.Any additional work than the above will be an extra charge. i 1777, %�����” /� �a �',,,/., 1,. /iii /, Date it SHINGLE COLOR ,4 Hoenmmowner is responsible Por ps r.ntectkrg and cloaning,J corifont of attic from possible dust and debris(luring your roofing project. Net rahsdxsanWbAe for Say h6ssues cm&,Ni byr am tod Any 112 ki.Plywood lrustµaltaQdon w4l be ami aidedtlsona� charge of$60,00 i'rer shoot Labor grad rimaler&aN We recommend new d0rnney tead with all new roofs for an extra chm gar of$'415 00 p*r cNnlney /2. 00068 COM � � ., 2-73 S395 a 41011 w The Commonwealth of Massachusetts _ Departtttent of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 Y �t s�• wwwmass.govldaa Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organp�,ization/Individual): 1 11L 4- A C_t-w-V ne,r— Address: City/State/Zip: V)p S fora cc, olfflo Phone#: OV) d5(,, - D333 Are you an employer?Check the appropriate box: Type of project(required): I.0 I am a employer with employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $• Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3. I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑ 0 4.F_J I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E] Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.[�(l am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[�Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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. I attt an employer that is providing workers'cotttpensatiott insurance for my employees. Below is the policy and job site information. Insurance Company Name: {- nnci uor"� ::�Y1So rcince co . Policy#or Self-ins.Lic.#:_,1,{)C ba3U 53 Expiration Date: (%V Job Site Address: 7� �l id Ci /State/Zi t,� �-- —City/State/Zip:p �lIrl 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. 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify r r to pants and penalties of petjrtty tltat the information provider!/a/b�ov is� and correct. Si Haiti Date: 5� 1pl �� Phone#: — ti 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 Pei-soft: Phone#: ACORD„ DATE(MM10DlYYYY)A CERTIFICATE OF LIABILITY INSURANCE 04/03/2015 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),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 NAMTACT E; ANDRE SILVA Rapo & 7epsen Financial and Insurance Services �aHc°;No,Eaq: 508-875-5600 (A/C,No):508-875-5885 1103 Commonwealth Ave E-MAiL ADDRESS: Boston, MA 02215 _ __-----_-_- INSURER(S)AFFORDING COVERAGE NA IC k INSURER A: Essex Insurance Company INSURED ECUAUSA CONSTRUCTION INC INSURER 8: AMGUARD INSURANCE CO 153 ARLINGTON ST APT 2 INSURER C: FRAMINGHAM, MA 01702INSU-R-- RER 0 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: EXPRESS ROOFER 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,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 INSR` TYPE OF INSURANCE ADDI:SUBR- POLICY EFF POLICY EXP LTR: INSR WVD' POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY LIMITS GENERAL LIABILITY TBA 03/12/2016 03/12/2016: EACH OCCURRENCE $ 1 000 000 DAMAGE"TO"RENTED r_ r__ X COMMERCIAL-GENERAL LIABILITY PREMISES(Ea occurrence) -�_$ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1 01-000,00 GENERAL AGGREGATE i$ 2 000,00 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- _ -- ---- —-- X POLICY; JECT LOC I$ AUTOMOBILE LIABILITY _ (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED INJUR BODILY Y(Perlde accni; AUTOS AUTOS $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS /Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ IS WORKERS COMPENSATION wc - E-, AND EMPLOYERS'LIABILITY R2WC623453 01116/2016'01/16/2016 X YIN TORY LIMITS,_ ER -ANY PROPRIETORIPARTNERrEXFCUTNEEF���------------��� E L EACH ACCIDENT $ B OFFICERIMEMBER EXCLUDED N I A (Mandatory In NH) E I. DISEASE-FA EMPLOYEE!$ 1,000,00 {t yes desar,t7eunlder -- _.__._ -_-- -_--_- ._- DESC,RIPTION OF OPERATICNS below EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C CELLED BEFO THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELI RED IN ACCORDANCE WITH THE POLICY PROVISIONS, EXPRESS ROOFER 4 mike@expressroofer.com AUTHORIZED REPRESENTATIVE 16 70NAS RD WESTFORD, MA 01886 ©1988.2010 A OR ORPOR TION. All rights reserved. ACORD 26(2010/06) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SiiperA iwr"iro dllklt� License: CSSL-099497 NUCHAEL L C i 16 Jonas Road lk m Westford MA 01$86 Expiration Coeiwmssm mer 04/24/2016 Office of Consumer Affairs&Business Regulation M�OME IMPROVEMENT CONTRACTOR egistration: 108126 Type: . r` xpiration: 8/13/2016 DBA MICHAEL L.CORTNER-EXPRESS ROOFING Kchael Conner 16,ZONAS RD rte' WESTFORD, MA 01886 Undersecretary