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HomeMy WebLinkAboutMiscellaneous - 135 MASSACHUSETTS AVENUE 8/3/2015 TOWN OF NORTH ;- " APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: f IMPORTANT Applicant must complete t all items on this page � � / ✓i/ ..,rrr r✓ l// x r / /c. ,::, ,/ .,,,. ;;:,, / ,..,,. ,"//,. /��i/// r it,✓i / ,/ a ,.r ,r ,,,,;. ,,, ,. r "' ' i ri ✓ /�%/ 9 r nor p y r�G/r /r..,rD, / r////�/r ri. / „y, / i//i / r r r/ / r , .. .r. / /. ..r. / r✓...r /... r /. ,, ,rr ,// ,.. / / % r it /�a r. /,,. r. /��'� r.. ./� f///,///��//�/ ,c,,,;. i �. //�: r i..✓ J r ;,,,, ,,, i r a r a/ / �/ / ✓ ./r ✓ �r r ,..ur i. .r� „ ,rrr. .r, Sfr�fct�ire r::r ,& J��/r% MAPNO ;PARCEL%rr/ /;/„/!ZON)NG x ISTRICT „i` HistorCc D�stnctrr ✓rrr / /r / ./r r /r rr/, r r rr. //i, / /✓ / J .../ r rr /�/ /rr yes no TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building 44-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic' ��Well g FloodplainC7�%Vetlands p Watershed District „ OlNater/Sevver. DESCRIPTION OF WORK TO DE PERFORMED: :gib w. a ` rint OWNER: Name: - \Identification' PI s Ty Y P1\ Nearly) Phone• r 6 Address: ,ri J r CONTRACTOR Name: �a, ,rr r Phone r/ rr r T c r �/rs” ,:, /i r„. /r ,lr,./ o / J v,,vi✓ r/ o.., rr :..:r / / i / rr. / / r/r J ” i�/�/i i,/acJ x/�����,� ',,,,, ,,,,`„ / ra/i// � , / ,,,, /� r rr/ �% / rir / r/////r// r// /r r/1, r „a ✓� ,i,rs Supervisor s,Construction License % �/trr Exp ,rDate r /�� t rr ���% r/ / � Nome lm / provement License � Exp Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ C Check No.: Receipt No.: ~YEA I NOTE: .Persons contracting ith unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor " ° -, µ Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans FORTH Town of - E , ndover ® _�61 y ?.o LAKE h ver, Mass, COC NI CNl WICK S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT La.4..I.A.N.4......................................... BUILDING INSPECTOR p g .p. 1r.1 A �C �................... Foundation has permission to erect .......................... buildings 9 ...........1 .�..M4�1i......... . .. Rough to be occupied as .............. ...... ... t L��f.�!!'1wi?.M ....................................... Chimney provided that the person accepting th s permit shall in every respect nform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws re ating 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS COSTRUCTI T TS 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. PROPOS WESTIMATIr: 170 Main St,North Reading,MA,01864 781-321-1991 WIN""I"ER HILL Claudio Araujo—License 05 105185 C;E?4E rtAL C C,�f4 I OP A4,""T C)K 1tvIC www.winterhillgc.com Arthur Laflamme Email:alaflamme007@comcast.net I 135 Mass Av.—North Andover MA Phone:978-687-1953 Date:06/26/2015 Job Location- Shingle Roof Tear Off: The following paragraphs describe the work that will be performed. * Remove existing shingle roof on the entire house and garage ® Install an 8 inch drip edge on all leading edges(Color: * Install 6 feet of ice&water shield on front leading edges&valleys * Hurricane Nailing:6(pails per Shingie ® Install starter strip on all leading edges. ® Install shingle mate felt paper on all areas not covered by ice&water shield * Install New Ridge Vent ® Install new vent pipe flanges ® Replace any rotten or damaged roof decking ledger board(vie allow 32 ft.at no charge..$3.501ft thereafter) ® Replace any rotten or damaged fascia or rake boards at$10.510111t. * Install new GAF Timberline High Definition Architecture Shingles * Remove existing lead fiashing on chimney,install.1ce&Water Shield,step flashing,and grind New Lead plashing into Chimney * Wanznty included in contract -(x)System Phis * Shingle Color 6P .1"' * Replace existing gutter with new seamless gutter ® All debris will be removed from the property Cost for Labor&Material for New Shingle Roof: $ 8,900.00 Payment Terms: 0 F') 113 deposit due upon signing contract: $ "Y lill payment due upon start of job: $ 113 payment due upon completion of job: $ Total Amount Agreed To Be Paid: $ Work Scheduled to Begin:— TED Job expected to be completed within 60 days of actual start date. Warranty:GAR guarantees all material for lifetime and work performed for a period of ten(15)years.If any problems occur we will cover the cost of all labor and m1terial to correct the problem and meet the customer's satisfaction. Claudio Araujo,-Pro'ect-Ma—hag-eir Winter Hill General Contractor,Inc. Date Home Owner Date The Commonwealth of Massqchusetts Department of IndiustrialAccidents X Congress Street, Suite 100 Boston,MA 0.2114.2017 www.mass.gov/dia Worlrers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH TEE PERAflTi NG AUTHORITY. Applicant Information Please Print Le0bly NaMe (Business/Organization/Individual): Address: n t 4— T City/State/Zip: ,� ) t` Phone#: 3 Z I 151 Areyou an employer?Checkthe appropriate box: Type of project(required): I am a employer with—-._employees(full and/or part time).* 7. ❑New construction 2. 1 am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3_r-I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 []Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.! 6.F1We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other 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. Homeowners who subniif 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-conlracfors have employees,tfiey must provide their workers'comp.policy number.• am an employer that is providing world rs'compensation insurance for my employees.' Below is the policy and jab site information. Insurance Company Name: / 16 Policy#or Self-ins.Lic.#: �'G` zo' zo - P03 i -1 L? -OZ Expiration Date: ® / J ` Job Site Address: s /VW1AS&Cb vS(1 VT3 City/State/Zip: P ` ' e(showing the olio number and expiration da Attach a copy of the workers compensation policy declaration pag ( g policy p ) 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 certi nder the pains andpenalties ofpetjury that the information provided above is true and correct. Signature: Date: ' Phone#: 1 � �� I 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#: �—•, WINTE-2 OP ID:JJ DATE(MM/DD/YYYY) ,d►coR® CERTIFICATE OF LIABILITY INSURANCEF �� 03/18/2015 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 CONTANAME; Crown Insurance Agency, Inc. Bradly S.Michals Insurance PHONE 617-924-1100 _�jAA,No): 617-926-2162 A ency,Inc. AIC No Ext): Main Street E-MAIL Watertown,MA 02472 ADDRESS___ _ Crown Insurance Agency,Inc. INSURER(S)AFFORDING COVERAGE IC# INSURERA:Acadia Insurance Company INSURED Winter Hill General Contractor INSURER B:Essex Insurance Company Claudio Mcuhna Araujo INSURERC,Arbella Insurance Co. 17000 170 Main St -- -- North Reading,MA 01864 INSURER D: INSURER E: 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 CLAIMS. INSR DDL UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Al OCCUR 3DX7960 02/13/2015 02/13/2016 D M GE Tom€ rE� 10O 000 PREMISESi � Ea occurrence $ MED EXP(Any one person) _$ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE$ 2,000,000 X POLICY JE� F-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Ea accident $ 1,000,ODU C+ ANY AUTO 1020001551 04/09/2015 04/09/2016( BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY accident) TYDAMAGE $ X HIRED AUTOS X AUTOS UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y A ANY PROPRIETOR/PARTNER/EXECUTIVE /N WC-20-20-003174-01 03/26/2015 03/26/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N❑N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under 500 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , ( ( I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Operations of The Named Insured CERTIFICATE HOLDER CANCELLATION XXXXXXX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR BIDDING ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR BIDDING ONLY ACCORDANCE WITH THE POLICY PROVISIONS. FOR BIDDING ONLY AUTHORIZED REPRESENTATIVE FOR BIDDING ONLY FOR BIDDING ONLY FOR BIDDIN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts . Department of Public Safety Board of Building Regulations and Standards a fOwa�eid p�«mr�� �arbeis$�f'd.b�.(pee P`p e^ri��aa^M"k 64Pei'i" License: CS-105165 ' is it Claudio M Araujo,-` 1.63 Hancock St"-N4 Everett MA 0214$ r ✓.(,.. ,�J ,�i,�,. ,r �.M Expiration Commissioner 07/13/2017 ��"✓^ �i CYCf dMvfi,YJ6d+d'KY4/#f%� . d�6W�P'.LD<'dl A'P'PJ.VJ'sY�n 1-11"'Z'7.;`',L Office of Consumer Affairs&Business Regulation Em� EllOMEIIVIFROVEMENTCONTRACTOR i�" 2Jr`6egistration: 168583 Typd: Expirat on:,.3!8(2017 Corporation WINTER HILL GENERAL CONTRACTOR, INC. CLAUDIO ARAUJO 170 MAIN ST NORTH READING,MA 01889 Undersecretary r