HomeMy WebLinkAboutBuilding Permit # 8/6/2015 BUILDING PERMIT of "°pT" q
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 1p-One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PERFORMED:
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Identification- Please Type or Print Clearly
OWNER: Name: +` ice=Z Phone: J (`4
Address: c - (
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $�' ; FEE: $ -�
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Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Signature of A ent/Ownera'
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g. ignature o
f:contractor 1
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TH Andover
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Town of
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BOARD OF HEALTH
Food/Kitchen
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P E MIT Septic System
91 �c Z BUILDING INSPECTOR
THIS CERTIFIES THAT •••• •.. • ......••••• ......•""""'
...........................................................
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permission to erect .... buildings on .. O. •Tim.�••• ••" """""has permis •• •••••• Rough
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to be occupied as .... ..... .............. ....... . ..... ...............................................
Final
provided that the person accepting this permit shall in every respect conform to the terms of thAltepat Alteration and
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, PLUMBING INSPECTOR
Construction of Buildings in the Town of North Andover.
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
IT EXPIRESI MONTHS ELECTRICAL INSPECTOR
PERMUNLESS C TI Rough
Service
. 0. .. ^ .... . .. ..,rT......................... Final
BUILDING INSPECTOR
GAS INSPECTOR
CCu�anCy e�' It eC/uired t® Occupy Building Rough
Final
Display in a Conspicuous lace on the Premises — Do of Remove FIRE DEPARTMENT
No Lathing or all o Be one
Until Inspected and rove the Building Inspector. Burner
et No.
Smoke Det.
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Residential
icrl Commercial Roofing ince .1l Types t
bryyp �S POINHEDRBUIpy APPE&
Siding Expert
GRMagBLy µ J$ >
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Mass Toll Free Licensed & Insured
1-800-WAITi-4_ }. Locally Owned& <.�j,eraled W."Zre 1976 �� License#034200
(e 24-£348 } 1 1 cin'' 0 3"�hw da3 We- Work "dear Round
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Proposal To: Chris Ramirez Date 8/4/2015
Street: 11 Old Farm Rd. 857-891-4642
N.Andover, MA
Roof proposal Chris_ramirez89@hotmail.com
IKO Cambridge/Certainteed Landmark
1. Extra caution will be taken to protect house 12.Building permit included.
exterior and landscaping as best as possible. 13. Contractor workmanship warranty: 10 years under
(tarps etc.)Magnets run at final clean up. normal wind and rain conditions.
2. Remove all shingles from entire house. 14. Install (1) diverter if wanted.
3. Inspect and re-nail any loose or lifted plywood.
Any compromised plywood will be replaced at Total IKO COSI: $10,2 -"""'
an additional cost of$65.00 per sheet of 1/2” Total Certainteed COS : �►10�800.0
CDX fir.
4. Install heavy gauge 8"white aluminum drip Both IKO and Certainteed direct ex non
edge to all eaves and rakes. pro rated 20 year fully transferable warranties
5. Install 6' IKO Armourguard or Certainteed included in this proposal. Please refer to
Winter guard ice and water shield along all pamphlets in estimate package. Offered and
eaves anmd top to bottom in all valleys. Install included to our local referrals in this proposal
full coverage on rear low slope roof line. at no additional cost.
6. Install IKO roof guard or Certainteed Diamond e Skylight option: Install(1)M04 VS manual
Deck synthetic underlayment to remaining venting skylight and flashing kit.
sheathing up to ridge. additional cost. Some minor cosmetic interior
7. Install all new pipe boots. finish work may be needed. Not included in
8. Install IKO Leading Edge or Certainteed Swill proposal
Start shingles to all eaves.
9. Install IKO Cambridge Limited Lifetime or *Note*: Please be advised if applicable,valuables in the
Certainteed Landmark architectural shingles to attic should be moved or covered due to minor debris,
entire house. 15 year non pro-rated warranty by dust and asphalt particles that will accumulate during
mfg. 10 year if Certainteed is chosen. All the stripping process. All Under One Roof not
shingles will be installed and fastened according responsible for any damage or clean up that may
to mfg, specs. occur in attic.
10. Counter flash chimney lead with ice and water
shield,tie into new shingles and seal with clear Balance due upon completion
Geo-cel sealant.
11. Install a new GAF Cobra ridge vent capped with References available upon request
color matched IKO or Certainteed hip and ridge
shingles. Hi6ly rated member of the accredited BBB and An-
gie's List
Thank vou!
—I —
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name(Business/Organization/Individual): CA UA<-
Address:
City/State/Zip: Phone#: '� 9 If �
Are you an employer?Check the appropriate box: Type of project(required):
LE]1 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. ❑Remodeling
any capacity.lNo workers'comp.insurance required.]
9. El Demolition
3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]t
10❑Building addition
4.[:]l 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 l 1.❑Electrical repairs or additions
proprietors with no employees. 12.E]Plumbing repairs or additions
5 1 am a general contractor and I have hived the sub-contractors listed on the attached sheet. 13.E]Roof repairs
These subcontractors have employees and have workers'comp.insurance.t
14.�Othe r
6.❑We aa corporation and its officers have exercised their right of exemption per MGL c.
re
152,§1(4),and we have no employees.[No workers'comp.insurance required.)
'Any applicant that chocks box 41 must also fall out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors 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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lia it: Expiration Date:
Job Site Address: // 0C-0 /r'IWI-'L N City/State/Zip:
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.
Ido hereby certify unde d1w sins ap"penalti s ofperjury that the information provided abov is true and correct
Si ature: f�1 Date: 2, �f S
Phone#: �l�� 92 - 15-
Qfjkial use only. Do not write in this area,to be completed by city or town ofjSeiaL
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#:
�+ DATE(Mlt/DDNYYY)
CERTIFICATE OF LIABILITY INSURANCE
i � 5/28/2015 ,r
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
131ftOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
RCPRl:sENTAT1VF OR pDnni1C�[it AFJD THE CERTIFICATE HOLDER. y
U00RTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the
e—ms and condtuons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
cwtificate holder In lieu of such endoisement(s).
^i'ivL)UCER --�---- -- ZCACT - —
NI Berk1gy Assigned Risk Services
E1n veTsai Insurance Agency Inc PHONE tAC.nss.E 800834-4589 Wc.Nay: (866)215-8118
374 Belmont St I—mss: PaticySenasces berkfeyriskc.cxim
�r��Ster, �� Q1�Q� 1 UREA AWORONG COVERAGE NAIC6
IrO RER h325
�' zJFiE6
t GG Construction Inc rNU�az s
IksugER c:
90 Congress St INSBURER D
Wilford,MA 01757 MIS LRM E
IkStRER F:
UO RAGES CERTIFICATE NUMBER: REVISION NUMBER:
^Trf15 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN fSStiEt)TO THE INSURED f SgMED 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 CONOITTONS OF SUCH POI,.ICIF-S.LIMITS SHAWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_
�tTR TYP£OF INSURANCE A L SUBR POLI CY NUiAt-R POLICY EFF POLICY EK LIMITS
.NSR Y1VD (lA NUppIYYY (Ia;,I/DpJYYW
GENERAL LIABILITY t
AUTO sr4OBILE LIABILITY I � $
WORKERS COMPENSATION 0TH.
AND EMPLOYERS`UABIL"Y �Y!N TORY L1pdT& OeR
ANY PROPRIETORIPARTNEFift"Y.E CUTNE C.�3 EL EACH ACCIDENT 1,000,000
OFFICE/MEMSER EXCLUDED,? c.� NfA WC-20-20-005650—M 'QJ/20/2015 j055120/2016
(Mandatory in NH) ft
If yes,describe under -E.L DISEASE-EA EMPLOYEE IS 1,QD0,000
GCSCRIPTDNOF OPERAT(ONSbelev I.._ E.L DISEASE--POLICYLIGlIT 1,000,000
= '.CRIPTpti CF OPERlcTIONS F CO-CAT IC IS 1 VEHIGLEB(AU&=ACORD TGI.AddiUzna?Rav--rks Schede.°@.If mire We«e isr¢quirttip
Coverage
U-SvIom Category Elect.Statin Name States) A!i Entiti��E ons-.-•----- .._._....._ .
Officer Include Maria Guaman MA MGG Construction Inc
93 congress St Wilford,SIA 01757
CERTIFICATE HOLDER CANCELLATION
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH.THE POLICY PROVISIONS.
%1I Under One Roofing AUTHORIZED REPRESENTATIVE
Temple St
Illilethuen, MA 01844 '
Signatures -'.y—
ORD 25(2010/05) RRA(,313q
�Jiassac:husetts Dep a, rncint of Pubhe Dceiise: CS-069120
JOHN W LANZAFAME
30 TEMPLE DR : Q
METHUENMA 01844
Ca�ni�iissi� �� 04/03/2017
click on the registration number to view complaint history. You can also view-arbitratigLi and Guaranty Fund
history.
The list is current as of Wednesday, October 8, 2014,
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REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS
NAME INDIVIDUAL NUMBER DATA
ALL UNDER*NE ROOF LANZAFA E, 137057 166 A MERRIMACK ST 10102/2016 Current
.JOHN METHEUN,MA 01844
o 2012 Commonwealth of MassacltuseH9.
Msss.Go1D is a registered service mark of the Commonwealth of Massachusetts.