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Home My WebLink AboutBuilding Permit # 8/14/2015 BUILDING PERMIT OtaoRrH �,�z,.eo TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION y Permit No#: I �y Date Received j I �SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION tJ SSL L% `+Print PROPERTY OWNER I �� ►` Print 100 Year Structure yes OnoMAPPARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r ❑ Se tic ❑Well ❑ Floodplain ❑Wetlands ` ` ❑ Watershed Distrrct ' r g^''Jrn. t rJ .,✓ rrt r , t f r � r ✓� s rr i'7'%ry�:r,��l✓�,r:. fufr,? r,�r f r',;. r,< DESCRIPTION OF WORK TO BE PERFORMED: r S 'r= �, Identification- Please Type or Print Clearly OWNER: Name: � , 1�- •'c"S Phone: Address: �� SS�- '� Contractor Name: �f t��1 ��i�1�� Phone: Email: Address: 3 0 n Supervisor's Construction License: f 0 tl Exp. Date: Home Improvement License: C7 5'7 !�- Exp. Date: t/ Ire f �� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i Total Project Cost: $ -5 ®� FEE: $ Check No.: )� 151-0 Receipt No.: � NOTE: Persons contracting with unregistered c tractors do not have access to tl a anty fund q innatuT(i(47E fir" rill-11 AM FORTH v J-6, r 0 0 No. A�� " ver, Mass 2AI, coL. c.11 .4 Q BOARD OF HEALTH vER T LD Food/Kitchen Septic System THIS CERTIFIES THATV-ew„ BUILDING INSPECTOR . . ........ .... ............. ... ........................ g �� .. � Foundation has permission to erect .......................... buildings on .... .. ......... .... � Rough tobe occupied as ...... . ...................................................................... Chimney ........... ......... .. .. .. . provided that the person acceptin 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 STARTS-UNLESS CONSTRUCTIO 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. CD Roofing Vincent Colangelo 3 Hodgson St. T• ewksbury,Ma 01876 0 -00 k 978-656-8497 vincentcolongelo@sbcglobal.net 40 ft HIC Lic# 170575 CSSL Lic# 105943 Customer: OWENS CORNING PREFERRED CONTRACTOR AL i4o d,�(.e Description of work Performed: ()_Obtain required town permits & provide certificates of insurance&workers compensation (+Provide Dumpster set on planks *for contractors use only(materials all recycled) ()'Attach Large Tarps to protect adjacent finishes, landscaping, and property. (,f Strip-off existing layers of roofing on complete house& re-nail any loose decking jY (),linstall8inch Aluminum Drip edging/Owens Corning Starter Shingles Install Owens Corning Ice&Water shield 6ft at eaves, 3ft in valleys, around all penetrations Install Synthetic felt paper to entire roof (")-Install Owens Corning LifeTime warranty TruDefinition Duration shingles 4X, Install new neoprene vent pipe flashings on all plumbing pipes (JInstall Owens Corning VentSure ridge venting with moisture guard '(ri-Install Owens Corning ProEdge hip& ridge cap shingles '(,,)-Completely re-flash chimney with lead '(,)'Owens Corning Preferred contractor installation with 00Wakafity` All work will be completed according to state and manufacturing codes and specifications. Every day we will have the roof water tight, clean gutters, completely clean the job site, and use a magnet roller to collect scattered nails. Additional work to be performed � All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteraijon or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tomado and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults, homeowner agrees to pay all costs of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of: dollars ($ Y t— eZ;', Said amount shall be paid as follows: f-:)ex Note:This proposal may be withdrawn by us if not accepted within days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. 'X, Work will not begin until your right to cancel has expired and you,have paid'a de�osit of dollars ($ unless this agreement provides'otherwis Signature of Contractor or authorized representative: *(I/We) have read the terms stated herein,, hey have been explained to(me/us),and(I/We)find them to be satisfactory and hereby accept them. N-1-1 Signature of Homeowner(s): 'J\ ........ i-)-5 Q 10-4,4 . 3 1P OV, R Id,-t bZIl,&4eF The Commonwealth of Massachusetts Department of IndustrialAceidents 1 Congress Street, Suite 100 Boston,MA 02114.2017 www.mass.gov/dna Workers,Compensation Insurance Affidavit:Builders/Contractors/Ejeetdeians/Plumbers. TO BE FILED WITH THE PERMTTING AUTHORITY- APPEcant Information Please Print Ledb ' r Name(Business/Organization/Individual): ` r (C411�PQ' Address: S�0 -) 5�" City/State/Zip: <-I-;A � -6 (, 6 ( 7 f Phone##: `7 _G 5` 6 7 Are you an employer?Check&e appropriate box: Type of project(Tgquired): 1.❑lama employer with employees(full and/or part-time).* 7. ❑New Construction 2.E]I am a sole proprietor or partnership and have no employees working for me in $, [1 Remodelirig any capacity.[No workers'comp.insurance required] ' 9. El Demolition 3..❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 F1 Building addition 4.F]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 1 L[�Electrical repairs or additions proprietors with no employees- 12. Plumbing repairs or additions 5. a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs 4These 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 MGL c. 14.0 Other 152,§1(4),and we have nQ 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. I Homeowners who submiti•this affidavit indicating they are doing all work andthen hire outside contractors must s4bmit 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-c'n[racfors have employees,VE 'must provide their workers'comp.policy number. I am an employer that is pYdviding workers'compensation insurance far my employees.',Below is the policy and job site information. /� r /; Insurance Company Name: All , J n Policy#or Self-ins,Lic.#: I-, Expiration Date: Job Site Address: C `q City/State/Zip: Atta&a copy of the workers'compensatioupolicy declaration page(showing the policy number and expiration elate). 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 cer 'y un e t epa- an lties ofperjury that the information provided above 'is true and correct. Signature: Date: ! �4/ Phone#: N, 7 Official use only. Do not write in this area,to he 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#: ® IFII 1 1( I DATE(MM/DDrYYYY) 4/23/15 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 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 editions 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 endorsernen PRODUCER CONTACT NAME: Angela Westen Insurance Agency PHONE g78) 735-4094 FAX No: (978) 735-4095 557 Central Street E-MAILADDRESs: angela@awesten.com Lowell, MA ®1852 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP FO CONSTRUCTION CORP. INSURER C: 40 READ ST. INSURER D: LOWELL, MA 01850 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 I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/DD/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY L021008696 3/18/15 3/18/16 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED-PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE D OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT—APPLIES PER PRODUCTS-COMP/OP AGG $ 1.000.000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMB INED—SINGLE L OFF a accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ — HIRED AUTOS AUTOS NON-OWNED PROPERTY DAMAGE er accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 2E112068 3/30/15 3/30/16 WC STATU- OTH- YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBERECCLUDED? N/A E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) If E.L.DISEASE-EA EMPLOYEE $ 100,000 yyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Renarks Schedule,if more space is regiired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CD ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. VINCENT COLANGELO 3 HODGSON ST. AUTHORIZED REPRESENTATIVE TEWKSBURY, MA 01876 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: VINCENTCOLANGELO@SBCGLOBAL.NET massAchusarm-0—=QartfmmtPub a ma- hts -e ar -_m of Pia c Safety --C r e�. ._�� ,-.,;rte ,,,t�., ,.•< €.,- r� _ .. L- ans CSSL-105943 Lorin ;CSSL-105943 VINCENT COLANGELO VINCENT COh4N&ELO 3HODGSONSTREFT \ 3H0DGS0NSTRE&T` Tewksbury 9A 018';* a - Tewksbury 44 ole? 03/091201.6 OW0912016 Oifiee of Consumer ARairs&Businas Re�ulatiou Cljo L� �^r/If�^f�.H�cfirrarlL. Ogee of Couaumer Affairs S Businas RePutatioo ME tMPROVEMENT CONTRACTOR n q gistrati. 170575 Type: ME IMPROVEMENT CONTRACTOR egistration: 170575 Type: piration: 1'1113?12015 DBA Pgyration: 11!f/Zo.5 DBA CD ROOFING CD ROOFING VINCENT COLANGELO VINCENT COLANGELO , 3 HODGSON ST _ 3 HODGSON ST _ TEWKSBURY,MA 01876 Underscer m- TEWKSBURY,MA 01876 Undersecrerary m83s e s_ e _y Of Pebl c sofety eQas 7 r ,- .� rg .gam, .� s .a Stag— Soar gug d R—q.ioationsd S a damp � --i .or :CSSL-105943 CSSL-105943. VINCENT COLANGELO VINCENT COLANGELO 3 HODGSONSTREET % _ 3 HODGSONSTREI+TV - Tewksbury MA.01816 Tewksbury kk 0I8?4 0310972016 3� - �3�_�_- _ 03/09=1 6 Office ofC nsumer Affairs&Businas Rs•�nlatian CYeor -.(t/f ff+r=+crrattf �k.\ OtTce ut Coo nsumer Affairs S 8usmas Regulation MEIMPROVEMENT CONTRACTOR ME7MPROVEMENT CONTRAGTOR _r'�g istraU, 170575 TYpe: gist o 11110!2015 DBA ,Registration: 170575 Type: piratian: 11710/2015 DBA CD ROOFING : CO ROOFING - VINCENT COLANGELO VINCENT COLANGELO 3 HODGSON ST 3 HODGSON ST _ O TEWKSBURY,MA 01876 UnderseereLan• TEWKSBURY,MA 01876 Undersecremry