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Home My WebLink AboutBuilding Permit # 9/9/2015 bUILUINU YtKMI I �/3= -" oc _ TOWN OF NORTH ANDOVER _ 3 A APPLICATION FOR PIAN EXAMINATION " 'r '/. Date Received ' °°° Permit NO:�s" 's`=A.,ao `ay Date issued: �1 IlVIPORTANT:A licant must com Tete all items on this a e LOCATION Frfit' PROPERTY OWNER � . P NO: � PARCEL.�,( Z ZING DISTRICT_: Eilsttiric Drstn }res noP �Jfadtin�Stsop Utli'aac�,,ids n � ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential New Building One family Li Addition G Two or more family ❑Industrial ,Alteration No.of units: 'i Commercial E Repair,replacement ❑Assessory Bldg E Others: ❑Demolition L Other 0 Septic Ewell, 0 Ft000pha'In C Wetlands. E.Watershed,District. r WaterlSewer ' Identification Please Type or Print Clearly) OWNER: Name: Le S c h}pct I,� Phone. Address: CONTRRCTC?R Nam Phone cf 5} Address: ,. Supervisor's Gdnstt oR Lilcertse " Exp Date: Home Irrlprovemerif0cense f Ft Exp: Rafe: ARCHITECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE.,BULDINGpP,ERMIT.'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASEDON$125.00 PER S.F. Total Project Cost:$ 7 70o FEE:$ Check No.: Receipt No.: NOTE+: Persons contracting w tl unreoistero contractors do not have access to the guaranty fund Signature of Agent/Owner � � _ Signature of contractcs "° Town of �Y" Andover o m No. 366—2101fe it soh " * ver,Mass, 7�A�A.1TEo r'PPy'(�J lS U BOARD OF HEALTH Food/Kitchen PER T ILD Septic System THIS CERTIFIES THAT..................M.'I.C.5.... .. .�! BUILDING INSPECTOR ........................................................... x `_ Foundation has permission to erect.........................buildings on.... 6�.1........ ..�.' !�..��.'................ p� Rough tobe occupied as........... ....�......... ..aroo ....................................................................... 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T TS Rough Service .............. .... ....................................................... Final BUILDING INSPECTOR GASINSPECTOR 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. Page No. Pages — Builders License 9 58443 Home Construction Reg.rf 167338 DluvaiAiL RoojiLng., 8 -1 (7 1]4-04 .444 (978)664-2557 READING NORTH READING - ,l P.O.Box 637.North Reading,MA 01864 Please visit us at ww"v vaalroofing cpm E'REEr cltt TATEANRZPCObE ' W,hereby submit specifications and estimates for the items checked in.tisce below; Rip&Remove all existing roof related debris from roof as well as job site.with,our own disposaltruck.NO DRIVEWAY DUMPSTERS Lf1 layer of existing roof shingles J2 layers of existing roof shingles :13 layers or more of existing roof shingles J Replace any damaged roof decking;not to exceed 32sq.ft. (additional at$1.70 per sq.ft) J Install 8'Aluminum Drip edge!Rake-edge along entire perimeter(Choice of White,Brown or Mill) Install ICE&WATER UNDERLAYM6NT on all horizontal eaves,sidewalls.skylights,chimney flashing::and valley areas =tt Install a premium base sheet undehayment(felt)thatis in compliance with the asphalt shingle manufacturer chosen by the homeowner J Install The Homeowners Choice of the selected TamkotlKO or GAF Limited Lifetime Architectural Roof Shingles. See individual manufacturer's warranty for specificdetails or please call us with any questions J Replace all existing bathroom louver and/or exhaust pipe(s)with new aluminum flanges d Chimneys)-counter-flashand re step existing€kaShing ❑Cut&Install new lead.flashing , Install a continuous low profile Ridge Vent on all ridge lines ' ❑Soffit-Vents: ❑Roof Louver-Vents J Seamless Aluminum Gutters-Custom fabricated on site with our own gutter machine J Downspouts at additional ❑Leaf Guards Attie Insulation-increase existing R.value to R.value with our own blown-ininsulation machine exclusively using GreenFiber cellulose insulation T - �JOther lease cover alt items of value in attic to protect from dust and debris We Prapoasse Hereby to furnish material and labor-complete in accordance with above specifications,for the sum of.. Z 1{'r a t- Total price not including options..dollars(S } Payment to be made:as follows. 3Q depcasii required before ordering materials:.Balance due in full upon day of completion. Please make all payments out to Kenneth(Duval,mailed to:P.O.Box 637,:No.Reading,MA 01864 Final Payment is due upon day of completion and is subject to the Authorized - supplemented Terms&Condition sheet when scheduling. Signature THIS PROPOSAL IS VALID FOR_DAYS DUE TO 4 FLUCTUATIONS IN MATERIAL&DISPOSAL.:PRICES. .'i The Commonwealth of Massachusetts Department of IndustrialAecidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 f www massgov/dia 'kers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT'T'ING AUTHORITY. Anulicant Information Please Print Legibly Name(Business/Orgaruzationgndividual):Duval Roofing LLC Address:PO.Box 637 City/State/Zip:North Reading,MA 01864 Phone#:978-664-2557 Are you an employer?Check ohe appropriate hos: Type of project(required): 1.21 am a employer with employees(full and/or part-time)' 7. New construction 2.❑I am a sole proprietor or pazmemhip and have no employees working for me in 8.❑Remodeling any capacity[Nowotkers'comp-in—..required.] 1[]l ams homeowner doing all work myself-[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑1 ams homeowner and will be hiring contractors to conduct all work ou my property.I will 10❑Building addition 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,E]1 am a general contractor and I have hired the subcontractors listed on it.attached sheet. 1's.�Roof repairs These sub-contractors have employees and have workers'comp.insurance: 6.❑We are a corporation and its officers have exercised theirright of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] ".My applicant that checks box k 1 must also fill out the sermon below showing their workers ompareation policy mimmation_ t Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and nate whether or not those entities have employees.If the sub-contractors have employees,they nmst provide their vorkets'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Travelers Insurance Company Name: Policy#or Self-ins.Lie.#:7PJUB-023ON91-9-15 Expiration Date:3/9/16 Job Site Address:953 Johnson street City/State/Zip:North Andover 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 thus statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information prouderove is true and correct Signature �/� �'�� Date L Phone#978-664-2557 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#: CERTIFICATE OF LIABILITY INSURANCE siiz/2ois f' 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' Barbara McDonough Gilbert Insurance Agency, Inc. PH°NE _(781)942-2225 6X .(781)942-2226 137 Main Street E-MAIL .bmcdonough@gilbertinsurance.com INSURER 5 AFFORDING COVERAGE NAIC 4 Reading MA 01867-3922 INSURER AHarle sville/Nationwide 26182 INSURED INSURER B;Plvmouth Rock Assurance Corp. 004154 Duval Roofing, LLC. INSURER c-Travelers Ins. Co. 0031 P.O. BOX 637 1 INSURER D: INSURER E: North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBERICLI411601329 REVISIONNUMBER: 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 POLICY EFF POLICY EXP LTH TYPE OF INSURANCE POLICY NUMBER M YSYY M NYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ Sr OOOr OOO B COMMERCIAL GENERAL LIABILITY PREMISESAGE"a tt $ 100,000 A CLAIMS-MADE®OCCUR L00000064158G 30/23/201410/23/2015 MED EXP(An -person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATELIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 5 2,000,000 K POLICY PRO- LOC $ AUTOMOBILE LIABILITY EOMBIN—INGLE LIMIT $ 500,000 ANY AUTO BODILY INJURY(P,,person) $ S B ALL OWNED SCHEDULED RC00001003Y99 10/23/2014 0/23/2015 BODILY INJURY AUTOX AUTOS (Peraccid.It) $ % HIRED AUTOS X NONO WNED PROPERTY DAMAGEAU $ umnsnrea motorist SI s lit limit $ 100,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ IXCESS LIAR CLAIMS-MADE AGGREGATE $ DEO RETENTION$ $ `` WORKERS COMPENSATION WC$TATU- OTH- AND EMPLOYERSTIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N PSDB-0230N91-9-15 E.L.EACH ACCIDENT $ 100000 OFFICERIMEMBER IXCLUDEO't ❑N/A (Mantlatery In NNl /11/2015 /11/2016 EL DIGEASE-EA EMPLOYE $ 100,000 If yas,desc be antler DESCRIPTION OF OPERATIONS trelow EL DISEASE-POLICY LIMIT $ 500 000 .ESCRIPTIONOFOPERATICNS/LOCATIONS!VEHICLES(A[bcM1 ACORp fol.AtltllaorcalflemarKS SCM1etlule,it mare space is regairetl) Evidenee of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ernnn oc ronsni ri 4i tlnac_omnerncn rneonoennm en„„hr„.e�e„,„,4 11M Massachusetts-Department ci Pubpc Safety �� Board or Building Regula?ions and St;xndards L ice as CS-058443 KENNETH P DIT" Po BOX 190 71 NORTH ST i - NREADINGMA 01864 =xpirailen Cmn. er 12/10/2015 Office of Consumer Affairs and Business Regulation NIP 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 167338 Type: LLC Expiration: 9/10/2016 Tr# 256221 DUVAL ROOFING LLC. KENNETH DUVAL P.O.BOX 637 - --NO.READING,MA 01864 —— -- Update Address and return card.Mark reason for change. SCA1 0 zm asiu Address Lj Renewal II Employment [ Lost Card