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Home My WebLink AboutBuilding Permit # 8/6/2015 %AORTH BUILDING PERMIT 0 96 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATIO� 4E Permit No#: Date Received 0".%rED PIV CHO Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION / 3 $- La -a '4LU\4 Print PROPERTY OWNER U1A (QCI� e, Print 100 Year Structure yes no C-) ZONING DISTRICT: Historic District yes no MAPa� PARCEL: Machine Shop Village yles,- no TYPE OF IMPROVEMENT PROPOSED USE Residlential Non- Residential ❑ New Building D-6ne family [I Addition [I Two or more family 0 Industrial 0 Alteration No. of units: 0 Commercial D Repair, replacement [I Assessory Bldg 11 Others: 11 Demolition [I Other fit' 00' DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: > Contractor Name: Phone: Email: A Address: 1�e c. Supervisor's Construction License: Exp. Date: Home Improvement License: N&.2 Exp. Date: ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED OIV$125.00 PER S.F. Total Project Cost: e2z FEE: $ c';') / If Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund b ron n n r "q �O TH Town t E } Andover 0 No. ® �AK. h ver, Mass, t�J COC HIcatWICK S t9 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • [- BUILDING INSPECTOR ' THIS CERTIFIES THAT ................... .Q4�1... ........ .. r. ......................................... rr� Foundation has permission to erect .......................... buildings on ...:II: ... .... !Ma:'!!�r1...� .......... F Rough to be occupied as ................. T....... t...Ire...�................................................................ 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ARTS Rough Service ...........,1...... ............ . ... .... . .......................... Final BUIL SPECTOR 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. ABCO ROOFING AND CONSTRUCTION 10 MEGHANN LANE LOWELL, MA 01852 FIC# 108424* SUPER CONTRACTOR LICENSE #092469 978-937-5840 AND 978®475-7544 PROPOSAL SUBMITTED TO: Mr. & Mrs.David Schmehl 135 Coachmans Lane N.Andover,Ma 978-208-8047 a. Strip entire main roof, and garage area down to boarding (entire roof) b. Change any plywood at a cost of$50.00 per 41x8'sheet of%" Exterior CDX if needed C. Install 8" Mill finish Drip edge along all starter courses and up all rake edges a. Install Full Coverage of WR Grace (select) on full shed dormer on back of house,and on top flat roofs on main part of house C. Install 6' of Ice and Water Shield on front mansards, along leading edges on back of main house, in all valleys,around all chimney flashings and vent pipes f Install new vent pipe boots on all vent pipes g. Install 151b felt paper on remainder of roof deck h. Install GAF(Timberline)Limited Lifetime Architectural shingles over prepared roof deck/Color: 1. Take away all debris from Job Situ daily %down,another I/4 when goof is half completed andmai der at completion of Job. C�9 Wo' � ' Abc t,u 4 Cost of Job as above: $ 18,000.00 DATE: DATE: e SIGNATURE: ff SIGNATURt---a2za� The Commonwealth ofMassci husetts F Department oflndustrialAceidents 1 Congress Street,Suite 100 - Boston,MA 02114-2017 sy;�wt www.mass.gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY- Applicant UTHORITY.A licant Information t lease P int Le 'bl Narne (Business/Organization/lndividual ' ,G f�'✓ Address: 1 City/State/Zip: Phone#: Areyou an employer?Checktlie appropriate box: Type of project(required): 1.0 I am a employerwith : employees(full and/or part-time).* 7. F1 New construction 2.❑I am a sole proprietor or partnership and have no ernployees working for me in 8. [1 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 F1 Building addition 4.❑I 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.Q Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[3-16of repairs These sub-contractors have employees and have workers'comp.insruance.1 6.Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14.F1 Other 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work andthen 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 employees. if the sub-contractors have employees,they,must provide their workeis'comp.policy number. d am an employer tfiat is pfoviding tvorkess'c ens 'on insur•an for my employees.' ow is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Da e: Job Site Address: r2 City/Statel p. Attach a copy of thew rkers' compensation policy declaration age(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 cer y der the pns 4enalties ofperjufy that the information pfovided above is/1,ue j correct. 6 �s Si nature: � 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE [EE21M /�DD/YYYY) T IFICATE 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 PRODU ER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT NAME: FRED C CHURCH INC PHONE 41 WELLMAN ST rAX (AIC,No,Ext): o): LOWELL,MA 01851 E-MAIL 29H5J ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: HARTFORD UNDERWRITERS INSURANCIi COMPANY GYS,JOSEPH DBA ABCO CONSTRUCTION COMPANY INSURER B: INSURER C: 10 MEGHANN LANE INSURER D: LOWELL,MA 01852 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIODIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS MADE F__1OCCUR. DAMAGE TO RENTED is REMISES(Ea occurrence) ED EXP(Anyone person) j$ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ POLICY []PROJECT LOC ENERAL AGGREGATE $ AUTOMOBILE LIABILITY RODUCTS-COMP/OP AGG $ ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT(Ea accident) BODILY INJURY j$ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DEDUCTIBLE $ RETENTION $ A WORKER'S COMPENSATION ANDis EMPLOYER'S LIABILITY YIN UB-0448N539-15 05/01/2015 05/01/2016 X WCLIMS ATUTORY OTHER' ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Q NIA (Mandatory In NH) E.L.EACH ACCIDENT $ 100,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATION S/LOCATIONS/VEHIC LES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR Cf?R77FICAIE ISSUED TO THI,CERTIFICATE HOLDER AFFECTING WORKf?RS COMP COVERAGE. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR GYS.JOSI:.1111. C7MERRIMACK OLDER CANCELLATION WELL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ST.RM 55 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIOA 01852 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP 'A`_ .r-' ifWf�tits reserved. 04/30/2015 10 : 53 : 28 AM FRED C CHURCH INC - 978-454-1865 PAGE 3 OF 3 Ara� CERTIFICATE OF LIABILITY IN DATEtMMI°°IYYYY> INSURANCE RA N C E dt,30/20,5 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(les)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 CO AC Marialana Crista,CISR Fred C.Church,Inc. NAME' _ 41 Wellman Street PHONE 978 3221248 AX --- --- Lowell,MA 01851 AIC No Ext: (AIC No) (V8)4186-5 54. (000)225.1665 ADDRESS: nx;osla@fredcchurch.com - INSURER($)AFFORDING COVERAGE NAIC p ---' --- INSURER A: Penn-America Insurance Company - 32650 INSURED ------- -------------------------- Joseph Gys dba Abco Construction INSURER B '0 Meghann Lane INSURER C---------------------- --- Lowell,MA 01852 INSURER D INSURER E: -------- --- --- INSURER F: �------- -- COVERAGES CERTIFICATE NUMBER--. '3REVISION THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN URED NAMED O ON NUMBER: ISSUED TO THE INABOVE 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 ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR ---_ POLICY NUMBER----- P� P�Y g - _— -------------- GENERAL LIABILITY MMIDDIYWY MMIDDNYW LIMITS X i EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY OREftTED-- 50,000 CLAIMS-MADEX OCCUR Pf2EMISES(Ea occurrence) ff - —__ A MED EXP(Any one person) $ 5,000 TBA 4/26/2015 4/26/2016 1,000,000 PERSONAL&ADV INJURY $ _ -- -'- GENERAL AGGREGATE $ 2.000,000 GEN'LAGGREGATE LIMIT APPLIES PER (------------- POLICYPRO LOC PRODUCTS-COMP/OP AGG S 2.000_000 — AUTOMOBILE LIABILITY $ OM INED N LE MI ANY AUTO Ea accident) _ $ ALL OWNED SCHEDULEL' BODILY INJURY(Per person) S AUTOS NON OWNED 80011_Y INJURY(Per accident) S HIREDAUTOS - AUTOS M Per accidenE_- $ UMBRELLA LIAR I $ OCCUR EXCESS LIAR EACH OCCURRENCE $ CLAIMS-MADE ------------ — DED RETEN710NSAGGREGATE $ ------- --._-._-__- WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC STATU. OTH- ANY PROPRIETORIPARTNER/EXECUTIVE Y!N T Y_SIMI _- OFFICERIMEMBER EXCLUDED? N/A E L EACH ACCIDENT S (Mandatory in NH) I_=_ _IDE Mes descriIeglON be uOF nder E L DISEASE EA EMPLOYEE $ SC` OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Compensation Insurance Certificate will be forthcoming directly from the carrier CERTIFICATE HOLDER CANCELLATION City of Lowell 315 Merrimack St,Rm 55 Lowell,MA 01652 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Office of Consumer Affairs&Business Regulation nfYr jy' fOME IMPROVEMENT CONTRACTOR =` 108424 : gistration: Type: xpiration: 8/18/2017 DBA ABCO ROOFING&CONSTRUCTION Joseph Gys 10 MEGHANN LANE LOWELL,MA 01852 ��'4` n -- Undersecretary Massachusetts • Department of Public Safety Board of Building Regulations and Standards Construction Supcn wir License. CS-092469 JOSEPH J GYS 10 MEGHAMN LANE' J LOWELL MA OF852 Expiration Commis stoner 09/27/2015 n[uCu�/[� n�';v�•.'([pJa['�tNN/Q Orrice Of Consumer Affairs& Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 108424 (OExplratlon: DBA 8/18/2015 TYpe: ABCO ROOFING&CONSTRUCTION Joseph Gys 10 MEGHANN LANE LOWELL.MA 01852 UnOfersccre(ary ' hr