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Home My WebLink AboutBuilding Permit # 8/27/2015 h l ILLI U Ia° Ft I I TOWN OF NORTH M APPLICATION FOR PLAN EXAMINATION ,„ Permit NO: Mo Date Received Date Issued: sAcaou I ® TANT: A22ficant must cam lete all items on this 2Me LOCATION ao U)"'i YA,rov ulv_cl Pt PROPERTY OWNER � � C(5nnMW , "" Print MAP NO: PARCEL: .� ZONING DISTRICT: Historic District yes (no o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential [INew Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer .- + (Ali L11 I 4 Identification Please Type or Print Clearly) OWNER: Name: Phone: 27Z_ 4,-2 ..,. i Address: CONTRACTOR Name: Phone: (77 7) Address: Supervisor's Construction License: Exp. Date. Home Improvement 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$125.00 PER S.F. Total Project Cost: $ 6i '/ 5b FEE: $ m Check No.: 222,a112, Receipt No.: �-!JZ, LL NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Signature of Agent/Owner Signature of contractor w �a dv t%ORTH Tuvvn ul liclover to Zb � LAKE h Ver' ass COCHI C"t WICK y1. �®A0RATE1) 7S U BOARD OF HEALTH rERMIT T IMF Food/Kitchen Septic System THIS CERTIFIES THAT `® C .N1,i.. BUILDING INSPECTOR S.. ............... .. ...................................... .......... has permission to erect ...............buildings on Foundation ....... .. ...... .......................... ........... ........,.. ® Rough tobe occupied as ........ .. ............ .......9Cr. . . . ....................................................................... 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 I *6M0 ELECTRICAL INSPECTOR LESS C R CS TRough Service .. ................. ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Puildin Rough Islay 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. Dempsey Roofing, LLC P.O. Box 383 Billerica, Ma 01821 Phone:978-670-8904 Fax: 978-362-3102 MWEEMENNNEMMMM" Proposal Customer "u " Name e Steve-Conngy --—------ Date 8/3/15 Job Site Route 114 )IA 6-1. n vo------ Order No. City North Andover Ma 01845 Date 0 Work 978-681-8571 Cell:978-886-2429 FOB ........................... O Unit Price TOTAL Install tarp from roof to ground to protect siding&landscape. Strip existing layer down to roof deck&re-nail where necessary. Any broken or rotten plywood/roof board will be replaced up to 1 sheet 1/2"CDX plywood or 16' roof board. Any additional additional replacements will be at an extra cost of time&material. Ice&water sheild underlayment will be installed as follows: main front eves to above 2 dormer ridge lines, 100% on back shed dormer, 6'on breezeway,side addition&under flashing along 2 washers. Install 151b felt paper or synthetic underlayment on reminder. Install 8"white aluminum drip edge around entire perimeter. Install LTD Lifetime GAF Timberline or CertainTeed Landmark architect roofing shingle(color and manufacture chosen by& homeowner). Remove 6'rubber on end of back flat roof area,then clean and install 6"cover tape. Counter flash and caulk chimney where necessary. Missing 1 piece of lead flashing on chimney, grind in &install new. Install two new pipe flanges(2"&4"). Remove,then reinstall heat cables. Install new ridge vent. Remove all roofing debris. This is a labor, materials,dump and permit proposal. *Back rubber roof needs some maintenance. Otherwise it is in good shape. To remove would be an additional$1500-$1800. Proposal good for 30 days. Ten year warrantee on all workmanship I .............. Total $8,750.00 Payment Details Minus $2,000.00 0 Cash $0.00 0 Check TOTAL $6,750.00 Office Use Only Makecheckout to�Dempsey Roofing LLC Signature of acceptance The Commonwealth of Massachusetts Department of Industrial Accidents ,gyp{ tel Office of Investigations 600 Washington Street + Boston, AIA 02111 )vwtiv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legible Name(Business/Organization/Individual): ✓�'z �� >� Address: R d City/State/Zip: lx,?I Phone #:q`7,5-- K, JC30G) Are you an employer?Check the appropriate box: Type of project(required): 1.4 I am a employer with r - 4. EJI am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. 2 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no 13.❑ Other 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. t Homeowners who submit 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information, Insurance Company Name: ` 63� Policy#or Self-ins.Lic.#: /��i'�C- L,3 -c b t V -1 �� Expiration Date: Job Site Address: .<� 611,LAIr 6 5+ 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c rf3 the sins and penalties of perjury that the information provided above is true and correct. Si ature: � Date: CK: J 7`Z S Phone#: (7 7 ✓Y Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building(Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: D/ZOI: UID ll : ZU :b4 AM, 8975 0 02/02 CERTIFICATE OF UABILITY HM)RANCE r CE"WATE DOW NOT Y OR NEGAINOTLY AN13ft MOM OR ALTER WE CUM31AGE AFFORDED BY IM POLUMS p ■. Maw_-o —2" - i AINRA p isc -337M C- � - — na°mm 1 E_ COVERAGES E: Im Ii TO CERTEV !fA® Tlr=FMICIES$=INS -M Aacw fm'ANS 1ffi r 4E/OR CQMWMMV OF Nff CSKMWr O OVIER DMS WM HEIFECr Ifit WKH IM MUMATIE " BE MUED @ mmHg TWEGROBIJUNCE ?EREMAL&AMMOW S ICgg�s-cxmmlpAGG S ANEMNOBRELIAMIEW Awjum �a $Rims AMUS AINM CLVAM Vater M A m �f "mumA EL- CANCEUAIM MWOFU E 1E '� "1M OATS '1i2OEM. ��L BE E 7230 � a7 a+cr�CORPOWRATM.Ag ria wed. 09/29/2014 1.03 Fri FAX 9788921492 YVFSOON wJ uouz/u00z 0923M14 12e PC Cott Plooliool C:ER-nnjFlCATE OF LJABILITY INSURANCE &-@ 9.11912014 OR Y -ex Lines Fxw000tt and Son Xnau=woo eXnc. C"21322-2350 MAILS wmamARadurance Amor�Lcao Eel Cc Dempsey Roori-9 X= E0 Boz 303 CERIEWAM a P MR � Id loo RED EW 59 s 9� as a - s 1 Loc OCHOCCURMCF r s a IA wVonPftodKWffrAv" a � Sss Departmentmof ulr)eau ��d ��p'��iry Board rP I13 ul'rpdiing Re ud afi ns and Sp aour#arcf menses L-099681 � to ERIC DEWS 7 RICHARDSO S ILLS ICA OI9 E air,Im r aP.o n :��rr rque ry»acr�� r 05/23/201 t� �✓ s ,n al�v' �/In,�,ld✓Ad'f�,hdd�"1u'BY A"d'�>'�A�' ��MS,w/✓(a�Ce�la'✓F�F Office of Consumer Affairs&Business Regulation L00ME IMPROVEMENT CONTRACTOR �yw egistrnfion. 178026 Type: ' xpWiration: 616/2016 I-LC DEMPSEY ROOFING LLC., ERIC DEMPSEY 7 RICHARD STS BIL.L.ERICA,MA 01821 Undersecretary