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HomeMy WebLinkAboutBuilding Permit # 7/2/2015 tfU1LUINU F'LKMI I UU,TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONPermitNO : �-1, Date ReceivedDate Issued: 1 AL i IMPORTANT:Applicant must complete all items on this page LOCATION '..baa �gLt31C ' PROPERTY OWNER (A.`cki Pnat MAP NO. PARCEL: ZONING DISTRICT: .Historic District'. yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential New Building Ci One family Addition E Two or more family E Industrial L Alteration No.of units: E Commercial - I I Repair,replacement ❑Assessory Bldg E Others: -1 Demolition Other C Septic E Well C Flobtiplaih olWetlands Q,Watershed District E Water/Sewer e3 rr14-1A Identifci�cation Please Type or Print Clearly) OWNER: Name: a G a�� Phone -7�'�� Address: CONTRACTOR Name; . Pfrrisn,e: . Address: Y Supervisor's Constriction Licerrse.,, Exp. Data ia! d3 ' t Home Improvement License: -3-5' Exp. Date. d p '.... ARCHITECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:Mao PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$123.00 PER S.F. Total Project Cost:$ NO" FEE:$ y Check No.: 12-Q2 Receipt No.: 2 4fzy NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of AgentiOwner Signature of contracto Town of Andover PERMIT � Ug" ��, ,�_ I �=.�°� THIS CERTIFIES THAT ................ BUILDING INSPECTOR Itshall in every respect conform to the terms of the application rin�l provided that the person accepting this permi.. 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 mthe Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES!N0MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Reugh � � ...............'_--__—............................... —' ommmowo�omnGAS INSPECTOR � OceupaneE Pernih Required to Occupy Bu Rrugh � Display inuConspicuous Place onthe Premises Do— � NoLathing mDry Wall TuBoDone FIRE DEPARTMENT � Until Inspected and Approved bythe Building Inspector. Burner � �}�=�' Page No. of Pages Proposal Builders.License#58443 'AI�� J" Home Construction Reg#767338 DuvaI A RocifLngUe (781}944-1994 (978)654-2557 READING NORTH READING P.O.Box 637,North.Reading,MA 01864 Pleasevisit us at www duvalroofing.com Wehe rysb t , fiv—r desti—for: J Rip&Remove all existing met related debris from roof as well as job site with our own disposal truck NO DRIVEWAY DUMPSTERS ❑1 layer of existing roof shingles 42 layers of existing roof shingles ❑3layers or of existing roof shingles J Replace any damaged met decking:not to exceed 32sq.@(additional at$1.70 per sq.ft:) �3 Instelin Aluminum Drip-edge/Rake-edge along entire perimeter(Choice of=White Brown or Mill) > Install ICE&WATER UNDERLAYMENT on all horizontal eaves,sidoweiis.skylights,chimney flashing and valley areas J Install a premium base sheet underlayment(felt)that is in compliance with the asphalt shingle manufacturer chosen by the homeowner Install The Homeowners Choice of the selected Tamko/IKO or GAF Limited Lifetime Architectural Root Shingles "Sae individual manufacturer's warranty for specific details or pleasecall us with any questions 13 Replace all existing bathroom louver and/or exhaust expels)with new aluminum flanges ©Chmney(s)-counter-flash and re-step existing flashing ❑Cut&Install new lead flashing. !Install a continuouslow profile Ridge Vent on:all ridge lines ❑Soffit-Vents O Roof Lower-Vents l Seamless Aluminum Gutters-Custom fabricated on site with our own gutter machine ❑Downspouts at additional Ll Leaf Guards -1 Other JRoof Insulation-Inorease existing.R.value to R_value X \ I � 39e ?rupuse hereby to furnish material and labor-complete In accordance with above specificatiors,for the sum of, ; s" E --I IP t'od,dir,options.doll (S 1 Payment to be made es follows: 30%deposit required before ordering materials.Ballance due in full upon day of eamplefion. Please make all payments out to Kenneth Duval,,mailed to:P.O.Box 637,No,Reading.,MA 01864 Final Payment is due upon day of:^ompletion and is subjectto the Authorized supplementedlerms&Condition sheet when scheduling. Signature - THIS.PROPOSAL IS VAUD FOR BAYS DUE TO FLUCTUATIONS IN MATERIAL&BtSPOSAL PRICES, // The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia IN orkers'Compensation Insurance Affidavit:Bnlders/Contractors/Electrieians/Plumben. TO BE FILED WITH THE PERbHTTLNG AUTHORITY. Applicant Information Pleass Print L ild Name(Business/Organi-fion/Individuap:Duval Roofing LLC Address:RO,Box 637 City/State/Zip:North Reading,MA 01864 phone#:978-664-2557 A—.an empl,-Che$the appropriate box: 1.,�i am a em 10er wim o to•cos aru aod/r Type of project(required): ❑ P Y mp> ( Part-time).' 7.❑New construction z❑Iamasole pcopriamr or partnership and bane uo employee¢workivg fotmelm 8.n Remodeling any capacin,[No worker¢'camp.insurance required.] 3❑Soma homeowner doivg allwork myself[No workers'comp.iauasvice required.lt 9.❑Demolition a.®lam¢homeowner andwal bel.^" duct alt work ovm 10❑Building addition g contractors to con y property-I will awe mat aP oono-aomrs eiuer esus workers•oompensation;naumnoeorare sae 11.❑ElecMcal repairs or additions propnetors.vith no employee:. 12. Plumbing repairs or additions 5❑Iamageneml contrac[orandi have hired the sub-convectors tiered on the attached sheet. Th13 Roof repairs ose suboontrnotore have employees and lu,worknn'comp.iusuravoel &DWe area corpvralion and its oflfi—lave exercised then right of exemption per MGL c. 14.❑Other 152,§t(T,and we cave m employeeu fX.wodrnra'camp.insuauce required] *Any applicant that checks box#1 must also fill om the section below showing chair workers'oompevsatiov policy ad— i-t Homeowners who submit this affidavit indicating they are doing all work and then hire outside convectors t submit a yew afrdatat indicating such. [Contractors t>at cheek flits box masa xnached anadditioral sheat showing[heroine ofihe subcontractors and state whether or trot those aunties have employees.If the sub-contractors have employees,they must provide their workers omp.policy number. I—an employer that is providing workers'compensation insurance for my employees.Below is the policy andjob site information. Insurance Company Name Travelers Policy#or Self-ins.Lic-#.:7PJUB-023ON91-9-15 Expiration Date 3/9/16 Sob Site Address 122 Chadwick Street City/Stute/Zip:North Andvicer Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL 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 oft STOP WORK ORDER and a fine ofup to$250.00 a day against the violator.Acopy ofthis statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby cetfi the pains andpena7ttes ofperjury that the information provided abave is true and correct S enamre �-� D t-7-1 Phone#9n8-664-2557 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#: n® ATE,e,oY a�ouO CERTIFICATE OF LIABILITY INSURANCE D 11/6/2o014o>rYY, 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 ceNficaie he'd.,is an ADDITIONAL INSURED,the policy(ies)..at 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 certifcafe does not confer rights to the certificate holder in lieu of such endorsemends). R cT Barbara R---'H Gilbert Insurance Agency, Inc. .(781)992-2225 137 Main Street .bmcdonough@gilbertinsurance.com aF Reading MA 01867-3922 —14-1esasville/Nationwide 6182 n u a:Pl outh Rock Assurance Co 004154 Duval Roofing, LLC. c�Travelers Zns. Co. 0031 P.O. Hox 637 North Reading MA 01864 I--s F: COVERAGES CERTIFICATE NUMBER 01.1411601329 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 REDUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO-I CH 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 MAV HAVE BEEN REDUCED BY PAID CLAIMS. L ,000,000 100,000 XNUAemtt c RCEIAL lu 10/z3/zG14 o/z3/zoa5 m =m 5,00D A IMSn E❑X 0 CUP L0000006415BG i,000,000 _ 2,000,000 2,000,000 L IGGREGIIE HMT—'Es XNv oBILE UA81— 500 000 R 0 X q - nc00001003799 l0/23/2pi4 0/23/2G35 p 111 X x Eo nuTo X A-1 EO - 100,000 eREiu Lwe �P U - CA.sE—Eas u-111 YIN cwoeor U-S x -0230x91-9-15 100.000 /11/2015 /11/2016 100 000 jManeai��iyEin xNl Ex loE _ 500 000 E'iaenoa or C_cs`g°eATI GPs rvEB�G�s Iwaacn All"rm,Aaaulonnl Rom1—sch—'o.11 P Iz P,ant CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 1600 Osgood St--t TIO—ED REPRBsexT la North Andover, MA 01845 M Gilbert, CIC/BARBAR ACORD 25(2010105) ©1988-2010 ACORD CORPORATION.All rights reserved. INS0251211Dos1O1 The ACORD name and logo are registered marks of ACORD E 3 O 0 a. w 3 —_�—_.. (J�l°ZP �fli!"✓I/Y07�' 4�'�-�E%4�Lr/J'.S�f/�l/(,//.1f�iL7/.!' Office of Consumer Affairs and Business Regulation -`-�- 10 park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 167338 Type: LLC Tr#256221 Expiation'. 9/1 012 01 6 DUVAL ROOFING LLC. _--- KENNETH DUVAL P.O.BOX 637 N0.READING,MA 01864 oPaacenaare sanaremrno a M k a:o t range. " L st Card Address ��Renewal L,Employment