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Home My WebLink AboutBuilding Permit # 8/28/2015 UIL IN PE MIT %AORT#1 TOWN OF NORTH N E � t APPLICATION FOR PLAN EXAMINATION Permit NO: i Date Received �,��kATED R� ..., �SSgcNus�c Date Issued: � �,�`; IMPORTANT:Applicant must complete all items on this page LOCATION ZAm-0_' PmtIf PROPERTY OWNER MAP NO: PARCEL: ZONING DISTRICT: Historic D yes MachineShop tno Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Flood,plain Wetlands Watershed:District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please ype or Print Clearly) OWNER: Name: Phone: Address: C - CONTRACTOR Name.` G . � Phone: Address: .. a Su -Exp Construction License: Exp. p Date. Home mprovement License: z -Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$9200 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. W Total Project Cost: $ /6-,2 ocoll ' FEE: $ Check No.: Receipt No. NOTE: Persons contracting with unregistered contractors do not have accertAlu7Zaranfund Signature of Agent/Owner Signature of contract , t%ORTH _t 0"'&wn oii nuvvul ® ® - % LANE h ver ass, 4'10� 0100- cild/fp CocMc MEW/CK �� QD RATE D P. �� U BOARD OF HEALTH Food/Kitchen PE �R� MIT 11 Septic System THIS CERTIFIES THAT a t® BUILDING INSPECTOR ...... ........... . ......... ..... .... .........� ............ .. ... .......... ........... .. ..... . .. has permission to erect buildings o Foundation ......................... .... .. ..........®.................. ..... ® Rough to be occupied as ......... .. ... ........ .. . .... ..... .... ....... .� ....................................................... 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 EXPIRESPERMIT IN ELECTRICAL INSPECTOR UNLESSTS 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 Lathan or Be® Wall To Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. WOOSTER ROOFINGPROPOSAL ALL TYPES OF ROOFS DATE: 5/28/15 &ROOF RELATED SERVICES Always Hand Nailed License Numbers: Charlie and Steve Wooster Construction Supervisors 54268 • - 1-888 ROOFIN-1 (766-3461) Home Improvement Contractor Main: 978 251-7181 Registration 100712 Serving MA&NH since 1984 Fax: 978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Mr.&Mrs_ ucoin Name Company Name Company Name Street 11 Tanglewood Lane Street City. No.Andover State MA Zip Code 01845 City State Zip Code Home#978 975-8255 Email seaucoin@comcast.net Work# Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following job. Strip the entire roof to the roof deck. 1. Renail any loose decking and replace any rotted at$2.00 per foot. 2. Remove hood vents and board in. 3. Replace section of two rear rakes where eaten by bees. 4. Install 8"white aluminum dripedge. 5. Install 6' of Grace ice and water barrier on all eaves and 9' on rear low pitched section. 6. Paper remainder of roof with Grace Tri-Flex roofing underlayment. 7. Install Certainteed Landmark Lifetime shingles,hand nailed. 8. Flash chimneys to roof. 9. Install new vent pipe flanges. 10. Install ShingleVent II ridge vent. 11. Clean and dispose of all debris. OPTION To strip and roof the rear of the roof only would be $8,250.00. Workmanship guaranteed for 10 years. We are fully insured with workers'compensation as well as liability insurance. Please return copy of proposal: All material is guaranteed to be as specified, and the above work to be performed in accordance with the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dollars), ($15,900.00), with payments to be made as follows: Job paid, 1/3 down and balance upon completion. Respectfully submitted—SVv 0v-p f Note-This proposal may be withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined bove. Date e/ 7–�Z,� Signature z � Mailing Address: P.O. Box 8051 - Lowell MA 01853 Location: 525 Woburn Street-Tewksbujj. MA 01876 The Commonwealth Of.lMlassachusetts Department ofIndustl^ialAccidents X Congress Street,Suite 100 P � tl Boston,MA 02114-2017 rvww mass.gov/dia. SJ• Workers'Compensation Insurance Affidavit:Builders/Contractors[Electrician/Plumbers. TO BE MED WITH TEG PERNJJTTING AUTHORITY. A licant Information Please Print Le 'bl Name(Business/Organizationftdividual): n .Address: City/state/Zip: / Phone#: 5 �s / Are yon an employer?ChecktIie appropriate box: Type of project()'squired): 1,91au aemployerwith_ - employees(M and/or parttime).* 7. ❑New construction 2,E]I am a sole proprietor or partnership and have no employees working for me in &. [j Remo delhig any capacity.[No workers'comp.insurance required] 9. ❑Demolition I Q I am a homeowner doing all work myself[No workers'comp.insurance required.] 10F]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 1 I.[:]Electrical repairs or additions proprietors withno employees. 12.F]plumbing repairs or additions S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 o rep airs These sub-contractors have employees and have workers'comp.insurance.: 6.0 we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have na employees.[No workers'comp.insurance required.] *Any applicant that checks box4l must also sill out the section below showingtheirworkers'compensation policy information. Haffi omeowners who submit this davit indicating they are doing all work andthen 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-conlraciors have employees,�1iey must provide their workers'comp.policy number. jam an employer thatispNdvidingworkers'compensation insuranceformy employees.'.Below is thepolicy andlob site information. Insurance Company Name: Policy#or Self-ins,LiG.#: G'�/G/ �' / `® � ExpirationDate: Joh Site Address: t'� C� G � City/State/Zip: Attach a copy of the workers' compen tion-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 verlficat, X do hereby cer fy un r the pain e altiP o' ry that the information pVee is tr et. Dat Phone#: Official use only. Do notivrzte 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#: ACC10RO CERTIFICATE OF LIABILITY INSURANCE 1ar��zo14 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 pollcy(les)must be endorsed. If SUBROGATION 15 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rightsto the certificate holder in lieu of such endorsement(s). PRODUCER AME AX McSweeney&Ricci Insurance Agency,Inc. PRONE 8 _ AtC o 420 Washington Street E-MAIL P-O.Box 850984 ADDRESS: g i co 6ralntree MA 02185 INSURER AFFORDING COVERAGE NAIC# INSURER A d INSURED WOOST-1 INSURER B Charles J Wooster dba Wooster INs11RERCc „ Roofing INSURER 0: PO Box 8051 " JNPURER E:- " Lowell MA 01853 INSURER F• COVERAGES CERTIFICATE NUMBER:2116766975 = 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. NOTVViTHSTANDING 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.LN[TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BE SUBS POUCYEFF POUCYEXP UNWMINSR TYPEOFINSURANCE POUCYNUMBER D° T DD A GENERAL LIABILITY CPAODW583 1011712014 Q/17/2015N EACHOCCURRENCE $1,000,000 X COMMERCIAL.GENERALLIABILnY - PR 19ES aecrarterr® $00000 _ CLAIMS-MADE 171 OCCUR MSDSP(AnyanspsrWM $5,000 PERSONAL&ADVTNJURY $1,000,000__ y:. GENERAL AGGREGATE $2.000,000 GENtAGGREGATE UMITAPPLIESPER_ PRODUCTS-OOMPIOPA6G $2,000,000 POLICY X IJECT PRO- X LOC _ _ - 5 A AUTOMOBILE LIABILITY MAA0379734 4/17/2014 $1,000,000_ BODILY WURY(For persorQ S ANY AUTO ALLOWNEDX SCHEDULED BODLYINJURY(Poraccdenq $ AUTOS N�WIEO PEfITYDAMAGE $ X HHEDAUTOS X AUTOS $ A X UMBRELLA UAB X OCCUR CUA0383967 0117)2014 1011712015 E&CHOCCURRENCE s1,000,OD0 EXCESS UAB US-MADE AGGREGATE ,1.000,000 DEDTX RETENrms0 ft $ g WORKERS COMPENSATION WC0720669 0/17/2014 011712015 X I WCSTATU- I IOTH AND EMPLOYERS!LIABILITY ANY PROPRIETORIPARTNEAIEXECUTVE Y/N EL EACH ACCIDENT $2,000,000 OFFICE3IIMEMBEREJ(CLUDED? Q NIA (Mandatory in NK) � - EL DISEASE-EA EblPLO $2,000,000 li yes,desalbo°rdar EL DISEASE-PO GY CBAiT $2,000,000 FOPERATiDNS DESCRIPTION Ohelve DESCRIPTION OF OPERATIONS/LOCATIONS]VEHICLES(AOech ACORD 1011,AddiOonal Her arks Schedule;H morespace is rewired) w sample .01 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sample ACCORDANCE WiTHTHE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t 0 t988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 9LOffivce of Consumer Affairs d Busmess Regulation 10 Park Plaza - Suite 5170 Boston,Massachusetts 0211.6 Home Improveotyt Contractor Registration - Registration: 100712 Type: supplement Card + Expiration: 6/23/2016 CHARLES J. WOOSTER_ROOFING = _ STEPHEN WOOSTER _ 525 WOBURN ST TEWKSBURY, MA 01876 Update Addmss and return card.Mark reason for change. - .- 0 Address Ej Renewal Employment Q Lost Card : SCA 1 0 2oM-05111 .. Office of Consumer Affairs and Busmess+Reofttion : - = 10 Park Plaza Suite 5170 Home Improvement.Contractor Regtstration' t Registration: 100712 Type DBA . Expiration: 612312016 .. Tr# 253696 CHARLES J;WOOSTER ROOFING Charles Wooster P.O: POMC 8054:. LOWELL,`NFA 01853 Update Address and return card `Mfi k reason for change. Address F1 Renewal �] Employment Lost Card SCA i si 26M-05!11 9 Massachusetts-Department of Public Safety Board of Building Regulations and Standards (-t,i11lt`UCI1,)jt .`it, att• {cn!' =:•i License:C"51288 a \• � Charles J Wooster, `'; ' d1L 40 P.O BOK#8051 Lowell MA-01853 a Expiration Commissioner 05/'11/2016 „+ v