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HomeMy WebLinkAboutBuilding Permit # 7/14/2015 BUILDING PERMIT %AORTH J'T%_E D ',6"6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION rj r�nt PROPERTY OWNER So "45 Y\,\, n Print 100 Year Structure yes I o MAP PARCEL: 0 OYl ZONING DISTRICT: Historic District y e no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 11 One family El Addition El Two or more family El I 'ustrial El Alteration No. of units: Commercial El Repair, replacement El Assessory Bldg El Others: El Demolition El Other t M, 01 N, om DESQRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: t\j 6 Supervisor's Construction License: CS 'I �_(:0� —Exp. Date: Home Improvement License:. .-.. —Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PE MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. -6 '21,?)-j- Total Project Cost: $ 11,01 5 FEE: $ e,,\ E�'o Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund A Y, iq natu� 1 F-1111111"4111 Irm F t4ORTH 11% d 0- v t _F. ...'.1,. e i vL own of ® ' ® VVr' Mass,� L / ' CO COCHICMEWICK y1• �®A04AT E D "'P�,`'�� % U BOARD OF HEALTH PERMIT T LD Food/Kitchen /�/... ... n \\ Septic System THIS CERTIFIES THAT .......... �4 .... Cl BUILDING INSPECTOR J l .. .. . .. . Foundation has permission to erect .......................... buildings on .. ............... ........................ v Rough e k0 O-P ...... Chimney tobe occupied as ............ ....... ...................................................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRESIN 6 MONTHS ELECTRICAL INSPECTOR _ SS CONSTRUCTIONSATS 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. f?0, Bo\ 185). '\1 c,r-th biile iC 1, -\,t,A 01 862 19-7 1 �j.�i-_1 ij�, F,71rC 19-81 063-2987 PROPOSAL SUBMITTED TO: Brad Reichter ADDRESS: 655 Middleton rd N Andover, MA DATE: July 6,2015 JOB SITE: Andover Sportsman Club WE HEREBY submit our proposal for the following scope of work: 1. Rip and remove existing metal&shingle roofs and dispose. 2. Install GAF Weather Watch ice &water shield to entire roof. 3. Install F8 aluminum drip edge metal to perimeter of roof. 4. Install GAF Pro Start starter shingles on rakes and eaves. S. Install GAF Timberline IID Lifetime architectural shingles to roof. 6. Install new pipe flanges to all pipe penetrations. 7. Install new lead flashing to all chimneys. 8. Install GAF Cobra ridge vent to vented ridges. 9. Install GAF Timber Tex cap to ridges. 10. Install white 6"seamless gutters to 2 trap buildings. Il. Issue GAF Weather Stopper System Plus Limited Warranty. 12. Clean site of all roofing debris. NOTES: 1)Any damaged roof decking will be replaced at$2.50 per s.f. (64 s.f. included) 2)If entire roof needs plywood,$8,900.00 will be added to total cost. 3)Rain diverters will be added above doors as requested. 4)Trap storage shed &wood shed included. 5)10% holding up to 2 rain storms,or 30 days,whichever comes first. WE PROPOSE to hereby furnish material and labor, complete in accordance with the above specifications for the sum of: Nineteen Thousand Five Hundred dollars. ($1 , .00 AUTHORIZED SIGNATURE: Just' . Morgan. oject Manager ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment will be made as outlined in TM Roofs Inc terms agreement. Authorized Buyer Signature: Date: 7 / tniroofshic.cont Thank you for choosing TM Roofs Inc. facebook.com/tmroofsinc The Commonwealth ofMasscichusetts Department of IndustrialAccidents f X Congress Sheet,Suite 100 - d Boston,MA 02114-2017 yV+y�t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 0 't, City/State/Zip: 1 . .� � Phone#: -7 " Ar u an employer?Check tlie appropriate box: Type of project(required): 11 1. am a employer with fl.. : 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 8. []Remodeling any capacity.[No workers'comp.insurance required] 9, ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 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 6.Q We are a corporation and its officers have exercised their right of exemption per MGI.c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have sub-contractors have employees,they must provide their workers'comp.policy number. employees. If the sub-cont I am an employer that ispi•oviding workers'compensation insurance for my employees.'Below is the policy acrd f oh site information. �r.� t� ., to Insurance Company Name: I " Policy#or Self-ins.Lic.#: w.w) (. Expiration Date: '7 1 Job Site Address: ,� / t \JA u' °c, City/State/Zip ANA04 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 un the tins andpenalties ofper jtuy that the information provided above is i u and correct. der �` m. � _,.... / Signature: Date: — 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TMROO-1 OP ID: LO LIABILITY � oATE(MMIDDIYYYY) CERTIFICATE 07/06/15 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 I 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 statefnent on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER PhOne: 781-935-8480 NAME. DeSanctis Insurance Agcy,Inc. Fax:781-933-5645 PHONE FAX 100 Unicorn Park Drive Woburn,MA 01801 ADDRESS; INSURERS)AFFORDING COVERAGE NAIC# INSURER A,Maxum Indemnity Company 26743 INSURED TM ROofS,Inc. - INSURER B:Plymouth Rock Assurance Group _._. _.... 1473., Tim Morgan Hanover Insurance Company 22,292 PO Box 185 INSURERC North Billerica,MA 01862 INSURER[):Star insurance company 012245 INSURER E;Evanston Insurance Co, INSURER F COVERAGES 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, 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 CLAWS. TYPE OF INSURANCE ADDL''SUBR -- — 1 POLICY EFF POLICY EXP — /LTR ___S_, ___. INS WVD POLICY NUMBER MMIDDIYYYY ! MMIDDIYYYY LIMITS 4 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 [MNERAL TO RENTED — - COMMERCIAL GENERAL LIABILITY 07101115 MREMISES{Ca occurrence) $ 100,000 GLP 6022460-03 07101/16 p A X CO CLAIMS MADE X OCCUR ED EXP(Any ono person) $ 6400 PERSONAL&ADV INJURY $ 1,000,00 —. — GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 — r- POLICY V X PRO- LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 'r ( {Ee accidenF-_ $_ 1'000'000 1 ALL OWNED SCHEDULED PRC00001604279 06/28/15 06126/16 BODILY INJURY(Per person) $ B ANY AUTO BODILY INJURY(Per accident) $ � B -1 AUTOS NON--OWNEDUTOS PROPERTY DAMAGE $ HIRED AUTOS X AUTOS {Peraccadenl) $ X UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ 5,000,00 E EXCESS ARETENTION$ CLAIMS-MADE MKLV10LE102351 07/01/15 { 07/01/16 AGGREGATE $ 5,000,00 V fi 1 $ AND EMPLOYERS'LIABILITY N/A WC STATU- 0TH _.__ TQRY L MI_C —.ER WORKERS COMPENSATION YIN N r WC0679514 ! 07/01115 07/01/16 E.L.EACH,ACCIDENT..._-__ $ __ 1,000,000 ,000,000 D OFFICERtMEMBER/EXCLUDEn�cuTivE N- 000 00 (Mandatary in NH) E.L.DISEASE-EA EMPLOYE $ , , If yes,describe tinder i E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below A Equipment Floater IHNA61062200 04/15/15 04/15/18 A Property Section IIIHNA61052200 -- 04115115 f 04115/18 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION REGIS-4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD S i C//, YiV ml;j(lC1w.;o11l 4 , Office of Consumer-Affairs&BusinessRegulation �IOME IMPROVEMENT CONTRACTOR Registration: 175609 Type: r `-'l'ExPlration: 5/24/2017 Co&p6ration r•� TM ROOFD INC TIMOTHY MORGAN 56 ROGER ST. BILLERICA,MA 01827 Undersecretary 99CAAss' huse s I)epa:,tgient r)r Pir Wic Sl IY Ve oart� of R Ilam, gt 1 t�: rs ar 1 S'lar t s j �"asarwtl taxa'°aErr:Saai:et l kifr License: G -0'956,53 f ;u TIMOT.RY RMtkGA°I, 56 ROGFIZS STR.FFT i p ILLF RICA MA:--0186 11 1`<t ✓ 119/2812016 1