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HomeMy WebLinkAboutBuilding Permit # 9/2/2015 00RT11 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 1114-� Date Received 'ds�popgrlo nPP`y , �$sacwus�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ; Print PROPERTY OWNER 0 ..- '. Y . Print MAP NOaPARCEL: ZONING DISTRICT: Historic District yes ;;4Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building t1,One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ci Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer , I Identification Please Type or Print Clearly) OWNER: Name: Phone: aM ,". ✓f...... Address: CONTRACTOR Name: Phone: 2 SIT.) .SLI Address: i Supervisor's Construction License: Exp. Date: Home Improvement License Exp. Date: F ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ) FEE: $ ., Check No.: Receipt No.: ° NOTE: Persons cant &ting With unregistered contractors do not have a s VA,eiguarantv fund Signature of Agent/Owner Signature of contractor 1� � t%®RT'H Town of n.dover 0 r 0 • ® 'Y O ver, ass LA COC NIC MlIC W.CK �® RATED BOARD OF HEALTH AN Food/Kitchen PEmMIT L D Septic System THIS CERTIFIES THAT ........ lov�� '� BUILDING INSPECTOR ... . . ........... ...lt ................P........... ............................... has permission to erect .......................... buildings o .. ......... . .. . . ............... ..4k..... Foundation Rough /� ...................................................... to be occupied as ................ ... ........ ....... ... .. .... ..w[ Chimney W or— provided that the person accepting-t permit shall in every respect c form 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 I860NTLI SELECTRICAL INSPECTORLESS TS Rough Service ........... ................................. . .................. Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required t® 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. XPNVAP o e T s�s!..e NO Craig LaCrosse-Owner s CONTRACT PO BoK 728,Tyngsboro MA 01879 August 31, 2015 978-580-7376 Craig@roofingkinginc.com Customer: Satish Tkalapialli Address: 21 Peterson Rd,North Andover MA Postal Code:01845 Phone: 508-329-4713 Email: tsatishchandra@gmail.com Thank you for allowing Roofing King Inc.the opportunity to work with you. Here is a list of the work to be completed,the agreed price and payment structure. Please feel free to contact me with any questions or concerns at the number listed above. SCOPE OF WORK: Full roof replacement -House will be covered with roofing blankets to prevent any damage and for easy cleanup -Remove all shingles right down to existing wood and re-nail and prep before installation process begins -install up to 96sq ft of rotted plywood(3 sheets 1/2 roof plywood)at no charge on any full roof replacement&$50 per additional sheet if needed -install 6 ft of GAF Storm Guard ice and water shield leak barrier along base of roof and areas listed below -Cover all valleys,snow load areas,under all flashings,wrap all penetrations including but not limited to chimney's and sky lights -Remove and re-install new plumbing flashing on soil pipes vented through the roof -Install Felt Buster on any exposed wood before shingles are applied -Install new 8" (color)drip edge on all edges of roof for proper protection -Install GAF Pro Start starter strips around entire perimeter of the roof to create a 1/2 inch overhang for proper install -Install GAF Architectural Timberline HD LIFETIME Ltd.Shingles will be storm nailed with 6 nails per shingle 130 MPH resistance -Cut 11/2 inch opening on peak of roof if it wasn't previously done for proper installation to meet building code(on full replacements) -Remove old lead around chimney and reinstall 12 inch lead and reseal joints(if applicable) -Install Cobra exhaust vent on peak of roof to allow proper ventilation and meet building code -Hand nail Seal A.Ridge caps on peak of roof with 2 inch nails to complete installation. -Blow off entire roof,driveway and all walking surfaces and clean any loose nails with 3 ft rolling magnets daily or on completion -Existing roof will be removed and recycled at Roof Top Recycling(Certified Green Roofer) Job Specifics and Upgrades (on full roof replacements) -Weather watch upgraded to Storm Guard Ice and Water Shield $0.00 Included -Remove skylight flashing kits to install ice and water on all 4 sides(reinstall existing kits) $0.00 Included -Deck Armor in place of Felt Buster $250.00 Not Included Warranty Roof comes with 50 Year Weather Stopper System Plus LTD manufactures warranty Promotions Military,Veterans and Retirees receive a$250 Rebate through GAF when purchasing a GAF Lifetime Roofing System. PAYMENT STRUCTURE: This price includes labor,material,trash removal,building permit if required and contract may act as signature for permit. (Any additional work will require separate pricing) Make all checks payable to Roofing ling Inc. Total: $8,000.00-$500 Act Fast Coupon(Exp.8131) $7,500.00 Deposit(due at signing): (1/3) $2,500.00 2°"Payment(due when material is onsite): $0.00 Final payment(due upon job completion): (213) $5,000.00 SHINGLE COLOR: SL- Initial: ACCEPTANCE OF PROPOSAL.The included specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above and accept all terms included.All discounts on all work to be done must be presented to Roofing King Inc.representative before contract is accepted. If rotted wood is discovered AFTER removing the existing roof,or it could not be identified at the time of sale an additional charge of$50 per sheet. If this account is collected through legal actions,customer will be responsible for all attorney fe nd court costs. D' losur ustomer responsible to cover any valuable items in the attic to protect from debris.Roofing King does not assume responsibility for acts of Mother Nature. Owner/Contract Property Owner Craig LaCrosse Satish Takalapalli fq The Commonwealth of Massachusetts W Department of Inilustrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Roofing King Inc Address:Po Box 728 City/State/Zip:Tyngsboro MA, 01879 Phone#: 978-580-7376 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(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. ®Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3. I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E]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.�Roof 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.E]Other 152,§1(4),and we have no employees.[No workers'camp.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:Star Policy#or Self-ins.Lic.#;WC 0742797 Expiration Date: � ,&, Job Site Address: � !A''` -1'7 � . YL City/State/Zip: � . Yd K,ii 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. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct, r 3 Signature: ' '2 ;t�t r� :r t Date: 4' ._ Phone#:978-580V,-7376 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#: ,Ac®R®® TIFI T I 'L' I u AN DATE(MM/DD,YYYY, 8/20/2015 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 CONTACT NAME: McSweeney&Ricci Insurance Agency, Inc. PHONE _ FAx 8807 420 Washington Street E-MAIL A/c No: - - P.O. Box 850984 ADDRESS:mrireception@mcsweeneyricci.com Braintree MA 02185 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Berkley RegionalInsurance Com 29580 INSURED ROOFK-1 INSURER B:Star Insurance Company Roofing King Inc INSURER C:Na i n n I 14788 Craig LaCrosse INSURER D: PO Box 728 Tyngsboro MA 01879 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:677678720 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 TYPE OF INSURANCE ADD R POLICY EFF POLICY EXP LTR SR WVD POLICY NUMBER MM/DDIYYY MM/DD LIMITS A GENERAL LIABILITY Y Y CGL 0059562-21 12/11/2014 12/11/2015 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $100000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 X POLICY PRO- LOC $ C AUTOMOBILE LIABILITY Y Y M1T5776F 8/20/2015 8/20/2016 COMBINE Ea accident $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED Ix SCHEDULED AUTOS AUTOS ( )BODILY INJURY Per accident $ x HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A UMBRELLA LIAB X OCCUR 000071022 12/11/2014 12/11/2015 EACH OCCURRENCE $2000000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION$ $ B WORKERS COMPENSATION WC074279703 8/20/2015 8/20/2016 WC SLATU- X 0TH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Roofing(commercial and residential)and siding operations. I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Roofing King Inc ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 728 Tyngsboro MA 01879 AUTHORIZED REPRESENTATIVE U ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD DATE(MM/DDffm) lC®RL>� CERTIFICATE OF LIABILITY INSURANCE 3/13/20115 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 NAME T Melissa Warren Risk Strategies Company PHONE ('JB1)966-4400 FAC Noll;fAI (781)963-4420 15 Pacella Park Drive E-MAIL Suite 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURER A:Scot tsdale Insurance Co INSURED INSURERB:Guard Insurance Group Junior T F Construction INSURERC: 406 Bridge Street INSURER D: #3 INSURER E: Lowell MA 01850 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1531391061 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 TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR CPS1914893 /11/2015 /11/2016 MED EXP(Any one person) $ 51000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOSNON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN —. ANY PROPRIETORIPARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBEREXCLUDED? F-1 NIA 2W627911 /11/2015 /11/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Evidence of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Roofing King, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 12 Malvern Avenue Tyngsboro, MA 01879 AUTHORIZED REPRESENTATIVE Michael Christian/MSG ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS026(201005).01 The ACORD name and logo are registered marks of ACORD IF imer Affairs& gusincv,Ref"uhlOoll 0 Ill c ofm 1%m D & ml k �tJOME W>ROVEMENT CONTRACTOR 17 Type:3 1�7 egistratiorl: CSFA-101415 xplraoow. /aid l Pnvate, CorporaOC l CRAIC,A LACRO$SE 12 NIALVFRN AVEMOt'/,,"`l/`,,l, F,,()l,)FH,3G MNG INC, TYlq("xSBORO KA 01;;' ROSSE CRWG LAC 12 MALVERN AVE. -1 Y Nl,"-,SBORO, MA 01879 06/2512016 ............. Iric ow%3,1,,1lA-`,S,EB,�o , This bard whrgWodoos Mat Om ax4poilt has o4o"4101(my ov*40"Oda mm"N"ifionai Vc Construction SaWy ood How* ....... M,