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HomeMy WebLinkAboutBuilding Permit # 8/26/2015 FORTH BUILDING PERMIT ®���LED Ib�tio TOWN OF NORTH ADOER APPLICATION FOR PLAN EXAMINATION -- � Permit No#.. Date Received DRA7ED Pep`�� �Ssgcaaus�`� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION .� Print PROPERTY OWNER ,f I Print 100 Year Structure yes UnoMAP PARCELS ZONING DISTRICT:_ Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic Y ❑Well ❑ Floodplain: ❑Wetlands �W atershed Dis nc p Water/Sewer: " DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: /7 /7 9%' `3 Address: Contractor Name: -:3 e Ml-% Q E A rJZ .) Phone• 3 7 Email: c_ ' Address: Jz Supervisor's Construction Licenser Exp. Date: "`�0 / p it Home Improvement License: / Exp. Dater ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT;$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /06`0 r FEE: $ I " Check No.: le) , P Receipt No.: �� NOTE: Persons contracting with unregistered contractors do not have access the guaran- fund N®RTFI Ar-111, AM -IMAS U CF Town of N — -- h y ver, ass, LAKE I`, COCNIC Nl WICK � A0 Qat ,9S RgTEoU BOARD OF HEALTH PmERMIT I D Food/Kitchen Septic System ... .. ..• ..• .. BUILDING INSPECTOR THIS CERTIFIES THAT ................................... .......................•.................."•'••"•' [Rough undation .. . .. ............. has permission to erect ............ ............. buildin On ..... ... .. .... imney ... .. ..... ... ....................fct�( to be occupied as .......... •• Final provided that the person accepti g this permit shall in every responform to the ter s of th 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCT rj Rough Service . ............................. Final .................... BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit e�gui�ed to ccupv Buildin FFinal is lay in aConspicuous Place on the Premises — Do Not RemoveIRE DEPARTMENT o Lathing or all To Be Done Until Inspected and Approvedby the Building Inspector. Street No. Smoke Det. iirrCorp. 62 High Street Everett, MA 02149 (617)-389-5611 Start Date: License # 083324 This contract allows Reg. # 103651 both parties to cancel within three business days Job Site: Taney 323 Dale Street North Andover, MA 01845 Terms: Strip and re-roof Contract. 1. Strip entire roof down to wood decking. 2. Re-nail all roof boards as needed. 3. Replace all rotted roof boards as needed, up to 100 lineal feet is included in contract price any additional footage will be additional charge of$2.50 per foot. 4. Provide and install ice and water shield per code. 5. Provide and install 8-inch aluminum drip edge around entire perimeter. 6. Provide and install new pipe boots. 7. Provide and install new ridge vent. 8. All flashing of chimneys,vents, and walls to comply with roof system. 9. Provide and install new 30 year architectural shingles. 10. Clean up and remove all job related debris. For the total amount of:$10,600. Deposit: $ Payment: $ Payment: $ Payment:$ Balance Due: $ Payment for this contract is set for a$1,000 deposit. Half of the balance when job is started. The whole balance including any extra's when job is completed. Contractor's signature: Responsible for payments signature: (Not responsible for damaged I ndscaping or fallen dirt or debris in attic cause roof work.) (There may be an additional charge if roof boards have to be changed.) (There WILL be an additional charge if roof has to be ply-wooded.) (Contract price allows for up to two layers of shingles to be stripped off,any additional layers will be an additional charge.) (Not responsible for space where siding of dormer meets roof,this space is due to the removal of multiple layers of the old shingles on existing roof and installing only one layer of new shingles.) (Not responsible for any lost signal from satellite dishes due to removing or moving them to perform roof work correctly.) The Commonwealth of Massachusetts Depaz"tment oflndustri rlAceldents d X Congress Street,Suite 100 ��"•...•.Sy�4�t Boston,AIA 02114-2017 YYY.fassgovld a Workers'Compensation Insurance Affidavit:Builders/Conti•actorslEZectricians/.Plumbers. TO BE MED'WITH TEG PERMITTING AUTHORITY. Applicant Information A� Please Print Legibly Name(Business/OrganizatioWhdividual): Address: ev.City/State/Zlp: PhoneL Areyon ane pI yer?ChecktIie appropriate box: Type of project(required): 1. am aemployerwithmployees(full and/or part-time,).* 7. []New construction 2.[]I am a sole proprietor or partnership and have no employees Working for me in 8. Remo delilig any capacity.poworkers'comp.insurance required.] 9. El Demolition 1[]Tam ahomeowner doing all work myself,[No workers'comp.insurance required.]t 10 []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.[]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. oof repairs These sub-contractors have employees and have workers'comp.insurance. 6.[]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Othbr 152,§i(4),and we have no 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. T Homeowners who submit klus affidavit indicating they are doing all work and then hire outside contractors must s4bmit a new affidavit indicating such. sConfractors 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-conkractors have employees, tiey must provide their workers'comp.policy number. p am an employer that is providing workers'compensation insurance for my employees.'.below is the policy and job site information. --7r Insurance Company Name: _____V ����J Mt-If Policy##or Self--ins.Lac.#: moo` Ol 2 z--2 Expiration Date: Job Site Address: �� q `-� y City/State/Zip: �� Attach a copy of the workers'compepsation•policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o.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 DLA for insurance coverage verificatio X do hereby certi un r tl ains an4p a ties ofpeljuly that t e informationprovidedAove is true and c rrec Signature: f - Date: Phone#: G Official use only. Do notwrite 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#: CERTIFICATE OF LIABILITY DATE(M A�® BILITY INSURANCE .6/11/® 6/11/15 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 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 CONNAME:TACT Sabatino Insurance Agency PHONE . (617) 387-7466 FAX No. (617) 381-9186 564 Broadway ADDAIL RESS: Everett, NIA 02149 INSURE S AFFORDING COVERAGE NAIC# INSURERA:Safet Insurance INSURED INSURER B:Northland Insurance Dipierro & Sons Corp INSURER C:Travelers 62 High Street INSURER D: Everett, MA 02149 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. POLICY EFF POLICY EXP ILTR ADOL SUER LIMITS INSRIWVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY B GENERALLIABILITY WS201237 5/14/15 5/14/16 EACHOCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100 000 COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurence CLAIMS-MADE F—I OCCUR MED EXP(Arryone person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2 000 000 POLICY PCLCaNd rGLELIMIT $ T OC AAUTOMOBILE LIABILITY 6232564 2/25/15 2/25/16 it) $ BODILY INJURY(Per person) $ 100,000 ANY AUTO ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ 300,000 AUTOS AUTOS NON-OWNED PROPEKTY—DAMAGE $ 100,000 HIRED AUTOS AUTOS eraccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WC STATU- OTH- C WORKERS COMPENSATION UB154869 5/14/15 5/14/16 AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACG DENT $ 100,000 OFFICERIMEMBER EXCLUDED? �N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describeunder E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if mares pace is regui red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DIPIERRO & SONS CORP ACCORDANCE WITH THE POLICY PROVISIONS. 62 HIGH STREET EVERETT, MA 02149 AUTHORIZED REPRESENTATIVE Rocco Loncyn © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: S iSgach }�+h'y e�arr;pyen2' f I , �on,StrUol7Oils "I �`ny4raii�h Q PVL/rc Licensn s e l'�1 y_j Q� V n4 1JF4 Sa fete CS-08 4�Y `)ABBY CD `. ., 3324 1 S3'calhor�� 0 Everett a Stream ,� ll�q p2144 b 5 Cornry�iss7 ExAi:-ar�o 081,312016 f ` Consumer �C�o�Pj�a ac�uleCG —` Office of Consumer Affairs& HOME IMBusiness Regulation r PROVEMENT CONTRACTOR e Registration:; = 182002 7 Expiration ;.5/18!2017 Type: DIPIERRO& Corporation SONS CORP CIRIACO DIPIERRO - 51 SYCAMORE ST EVERETT, MA 02149 Undersecretary