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HomeMy WebLinkAboutBuilding Permit # 9/25/2015 W BUILDINGPERMIT 0 �Q og��� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION pg _ P Permit No#, � '� `� Date Received 161 �SS„q C HUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION � G�ru PROPERTY OWNER W t t �PInt � rA Print 100 Year Structure yes no MAP PARCEL: ° ZONING DISTRICT: Historic District yes no Machine Shop 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 p Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: OWNER: Name. I Identificat a/\ ! „�� M1 Ire, fl ddb ��r" k I'• ' Location °...� ... Address: Oma ' '° No. Date Contractor Name: > °° Email: TOWN OF NORTH ANDOVER Address` ;i " 'i Supervisors Construction Licen Certificate of occupancy Building/Frame Permit Fee $�� Home Improvement License: �{ Foundation Permit Fee Other Permit Fee $ ARCHITECT/ENGINEER TOTAL $ Address: I FEE SCHEDULE:BULDING PERMIT. $9� Check#—t-1 • w,. Total Project Cost: $ , „ Building Inspector Check No.: IM NOTE: Persons contracting Signature of Agent/Owner ignature of contracto ®RTH Town of ndover ® VA ® 2o(!5 LAKE ver, ass, • coc"Icn@wecK y1' �D�RTED 'e U BOARD OF HEALTH Food/Kitchen PEmMIT T D Septic System THIS CERTIFIES THAT ....... BUILDING INSPECTOR .... .....�. .. .�.. ... . ...... .......... ... ........... ....... . ..... . . . . ........ .. ... ..... . ...... Foundation has permission to erect .................... build]n s on .. .. ... ............. .. ... ... . ®....... Rough to be occupied as .. �. ... ...... ... . . .. ....... ......'.. ..... . :� . `'. ........ ..... �!!-... ..... ................ Chimney provided that the person accepting this permit so I in eve res t cform to the t s of thea application p p p g p every p pp 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUT Rough Service F ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Bu Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No �,: t $Na��e'-� s y Owens Corning Preferred Contractor#212828 GO OSHA 30 Hour Construction SafetyTraining EPA Lad Safe Cetiiffied 0x.=._✓ rpt^ aeffeaa^W c®i7te�aCflPrgs N l J P,f fee -,r s 51 S. Broadway#2214 a Salem, NH 03079 r (603)8900094 110 Stevens Street#141 Andover, MA 01810 (973)475.0095 PROPOSAL SUBUTTEUTO / PHQYE a DATE Ji_?l (e+i-to"1 I .ti.4"aC_:'..,t=l �l � ( a � f tom•. STREET _ _, TWL ! )'l,e L't:. ,ti- iia::' ( .:tc, �l'l<' £ �V31C.c:a'i rla'Y CAN.STATE,AND ZIP CODE JOB LOCATION Completely protect the home with tarps to catch falling debris.Respect and protect shrubbery and flower beds. Strip off d layers of roofing material down to the bare roof deck.Inspect the roof deck for structural defects. Determine the condition of the underlying plywood or boards,and repair and replace as necessary'. Inspect roof ridge for proper 11/2"spacing on either side of ridge for maximum exhaust ventilation.Cut in if necessary. Install new heavy gauge (,,:I'tr'tc_ (color) drip edge at roof eaves. Install -�' 'tib tFr's 'cAti';> ice and water shield to meet manufacturer's specifications(i.e.6 feet from roof edge,3 feet centered in valleys,around all skylights,chimney bases,roof penetrations and at all sidewall transitions). Install I-)='G�, --�t;vac, breathable roof deck protection to remainder of the roof deck. Install new heavy gauge !'-, 1�.1 i (color) drip edge at roof rakes. Install f>r''c `=3i r; - starter strip at roof eaves and rakes. Install (,-�r vt(1'-i �1-�'t !i l� +rZ 4z L, desired color. 77 (color) Install new flashings to meet manufacturer's specifications.(i.e.sidewalls,chimneys,skylights and roof penetrations). Install r 1 cf (feet)of ! ) ;> 5"':-u(," 6 t_^lk.i ridge vent at roof ridge to allow maximum ventilation. Hand nail to ensure proper fastening. Install I=3 (feet)of 9 r:VI _z X distinctive hip and ridge cap.Hand nail to ensure proper fastening. Thoroughly clean up and dispose of all roofing debris on property.Magnetically sweep property for nails. Notes: I—�•t�'� `P"l �–:1,)t}1r x.) 7tl �Vi, ti, c)F1 r < Cd /'�{ I t yF1't1 L..' 4t.a L a i1 ( v t 11 i,. 'e, —�� f is Edmunds General Contracting will: o Obtain all necessary construction-related permits to complete this project. a Perform work as efficiently as possible without sacrificing quality. o Furnish and install all necessary materials to complete the project. m Provide a thorough clean-up and disposal of all debris generated during project. Z` Edmunds General Contracting LLC agrees to commence work on/or about _ and described work will be completed in about'!'! .. days. Product Upgrade 1: �•'}ti�fl 1�Ic'vs;)S Cs i i I'�+` j +� `�iyli zit 4"J, Product Upgrade 2:T1 - r,st I&S' yt CA�LU ��ti d .t/4 cC" 9t" t� t,"A u',,c4�t'r. Contractor's employees are fully covered by workmen's compensation and liability It is further agreed that this contract may be assigned by the contractor,and also insurance. that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties. Upon completion of the above work,all undersigned agree to execute and deliver to the contractor,their joint note in accordance with his(their)above obligations as Edmunds General Contracting LLC guarantees all workmanship performed for requested by contractor.Upon refusal to do so,contractor may at its option declare ' years. the entire contract price or so much as then remains unpaid,immediately due and y payable.It is agreed that,if permitted by law,contractor shall be paid by the We will register d i°1 C�t,—S factory enhanced warranty owner(s)all reasonable costs,attorney fees,and expenses,in addition to the providing-,z` years of material defect c verage and years of amount due and unpaid,that shall be incurred in enforcing the terms and conditions workmanship defect coverage through •l-i for: of the contract and/or any lien in connection herewith. no charge the additional cost of 'Edmunds General Contracting LLC will provide the materials,labor and�dis�posa�l to�re=place up to 64 sq.ft.of roof decking and 20 it of fascia at no additional cost. Any additional materials including labor and disposal vAll be replaced at 7W per sheet or •�a r c'rl linear foot. Edmunds General Contracting,LLC agrees to furnish the material and Nl ma extol is guaranteed asspe hed.Nlrvrk la be mmp�ted ine—kmantke manmeraccurdrg tos andard practice.Any alteration w deviation from abovespecifcstiona inwhing extra costsvAll be executed onN uraivnilkn labor complete in accordance with the above specifications,for the sum orders,and tvi8 became an extra charge Wier and above the stated contract pace.Contractor is not responsible for Of ,fl_•�;' .,. ti `'� j;damage due le high v,inds,to..does,hurricanes,fire or other tlarards.0rmena)agree to carry the tamed.and other ,et,,'/ '.'d�,;.-> '10 t�:� t (� dollars($ necessary insurance.Contractor is considerate of mmefs landscaping and bur due to the nature of the morins installation some damage may occur.We attempt to minunrze any damage,and till not be held responsible if any damage o wrs. contractor is art tesponsiA'a for any damage lathe xinterior of prw ty,ntluding pe-e null Pa merit Terms: candir.r.(.e.tale,staNs,cunubMg phster,exposed nails)or comJft;resul6mg tram application of materials as Y specified.ba e.items'. ems m the atfie may need le be sward by the a.—r.Contractor u not responsible for damage A depositofAT575J6} (not to exceed 1/3 of the total contract)is ..Id by ice dam bulld-up.All agreements are conbpgent upon strikes, accidents,a delays beyond our control. due upon start of work.The balance of.�15'CYf�� is due when work Authorized Signature: r' f�k- ���'• . is completed to the satisfaction of all parties. ✓Edmunds General contracting LLC A finance charge of 1.5%per month(18%per year)will be charged on Note: This proposal m�1y,be withdrawn by us if not accepted within past due accounts over 30 days days. 9cre Jtii u e Of VTopo2;ar -The above prices,specifications,and DO NOT SIGN THIS CO IFTHERE ANY BLANK SPACES, conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will a male as outlined above. Authorized Signature: Date of acceptance: a� Authorized Signature: �� The Commonwealth of Massachusetts Department of IndustrialAccidents " = 1 Congress Street, Suite 100 Boston,MA 02114-2017 ' www mass,gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE riff ED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leizibl Name(Business/Organization/Individual): Address: '4 t ,� Z' - ( wa0-7 City/State/Zip: lJ Phone#: p' -7 7'3' A7yoan employer?Check the appropriate box: Type of project(required): 1. m 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 ❑ 44.F]I am a homeowner and will be hiring contractors to conduct all work on 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. 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.insuzance,# 6.❑We are a corporation and its offrcers have exercised their right of exemption per MGL C. 14.❑Other 152,§1(4),and we have no,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. i Homeowners who submit#his affidavit indicating they are doing all work and then 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 state whether or not those entities have employees. If the sub-contractors have employees,iliey must provide their workers'comp.policy number. lam an employer that is providing workiers'compensation insurancefor my employees.'Belorp is the policy and job site information. Insurance Company Name: t-1" l +e' y-,A Policy#or Self-ins.Lie.#: W(- _ 2...� f " "'2_... Expiration Date: 6/z,6 Job Site Address: > C t" m City/State/Zip: / a t, ✓ + Attach a copy oft the workers'compensaon 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 WORD 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 DTA for insurance coverage verificatip . Ido hereby ertify u -I 2e pains and penalties ofperyury that the information provided above is rue and correct. Si natureP ...... Date: Phone# � C.C°a 5 2.- official use only o not ivrite in this area,to be completed by city oi-toivn 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.PIumbing Inspector 6.Other Contact Person: Phone#: DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE F9/18/2015 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). CONTACT PRODUCER PLANRIGHT INSURANCE&FINANCIAL LLC NAME: FAX No: 224 MAIN STREET STE 3C PHONE (AfC o Exit, SALEM, NH 03079 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INsuRERA: LM Insurance Corporation 33600 INSURER B INSURED EDMUNDS GENERAL CONTRACTING LLC INSURER C: P 0 BOX 2214 INsuRERo: SALEM NH 03079 INSURER E INSURER F REVISION NUMBER: COVERAGES CERTIFICATE NUMBER! 26473324 E BEEN ISSUED TO THE INSURED NAMED ABOVE R I HE INDICATED.STO CERTIFY TjTAT-THE ANDING ANY REQUIREMENT,TERM OER CONDITION V F ANY CONTRACT OR OTHER DOCUMENT WITH REO PECT TOLIWHICH 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 POLICY F PAID POI CCLAIMS. LIMITS ADDLSUBR POLICY NUMBER MMIDDIYYYY MM/DDlYYYY INSR TYPE OF INSURANCE EACH OCCURRENCE $ LTR COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS-MADE 0 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ PRO- ❑LOC $ POLICYF—]JECT OTHER: Ee acBlc dEDLSINGLE LIMIT $ AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED PROPERTY DAMAGE $ AUTOS AUTOS Per accident NON-OWNED $ HIRED AUTOS AUTOS EACH OCCURRENCE $ UMBRELLALIAB OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE $ DED RETENTION$ 1/26/2015 1/26/2016 PER OTH- ERA WORKERS COMPENSATION WC5-31S-369752-025 ✓ STATUTE 500000 AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A E.L.DISEASE-EA EMPLOYE $ SOOOOO OFFICER/MEMBER EXCLUDED? 500000 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER, MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE J� n✓/ J _(^()�� LM Insurance Corporation O ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD aonkar 1 9/18/2015 10:41:30 AM (EDT) I Page 1 of 1 26973324 11-369752 15-16 [9C Ashish Borg ��e �pa��r��zo7rcoeal��a���cc�aac�u<1e� Office of Consumer Affairs.&Business Regulation j OME IMPROVEMENT CONTRACTOR egistration 166661 Type: ,Expiration 612112016 Corporation EDMUNDS GENERAL CONTRACTING, LLC. DAVID EDMUNDS 18 ASHFORD RD HAMPSTEAD,NH 03841 Undersecretary ' License or registration valid for individul use only II I _ before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation . 10 Park Plaza-Suite 5170 Boston,MA 02116 I Not ►d ut signature I . l Massachusetts-Department of Public Safety Board of Building Regulations and Standards I Construction Supervisor License: CS-104728 DAVID C EDMUNpS P.O.BOX 2214 2 SALEM NH 0307-9Al , ✓� .�.f.� �t'Itt FYriir�4ir;w. '.