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HomeMy WebLinkAboutBuilding Permit # 9/29/2015 BUILDING I? TOWN OF NORTH ANDOVER APPLICATION FOR FLAN EXAMINATION � Permit NO: I° ,� Date Received Gate Issued: )F' ACHU IMPORTANT: Applicant must corn fete all items on this page LOCATION I iv fit~ Forint .. PROPERTY t ER \ / � " Print MAF NO: Nr;- FARCELI _ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non® Residential ❑'New wilding Ona family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer S+62 Identification Please Type or Print Cleary) OWNER: Name: fyN t 1 ' . Phone: Address: CONTRACTOR Name: �_�Fhone: o") A- ��- �- 7 �. (at Ck � tc V13, Address: � , Supervisor's Construction License: i Exp. Date: Home.Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 of THE TOTAL ESTIMATED COST EASED ON$125.00 PER S.F. "total Project Coat: ��S FEE: $ Check No.: ..-0"tReceipt No.: 1)LJ ,-L NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor %AORTH Town of 111 .7'o ndover ;O�0 L*- h ♦ er, ass, COCNICM@WICK y1. ® 01 A04ATEo S U BOARD OF HEALTH Food/Kitchen PE �RMIT T D Septic System THIS CERTIFIES THAT , .. (,�......................................... BUILDING INSPECTOR has permission to erect ..... buildings,on _ Foundation Rough tobe occupied as ............ ....... ......... .......... .. ....Y ........................................................... Chimney provided that the person accept this permit shall in every resp t 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 I ELECTRICAL INSPECTOR UNLESS TI Rough Service ..................6- TH .... ...................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® OccupV Building Rough Display in a Cons icuousInce on the remises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Craig LaCrosse-Owner ® ESTIMATE PO Box 728,Tyngsboro MA 01879 September 2, 2015 978-580-7376 craig@roofingkinginc.com Customer: Mike Asselin Address:174 Green Street,North Andover MA Postal Code:01845 Phone:413-530-5117 Email: mikeasselin@icioud.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 -Clean all gutters and downspouts(if applicable) -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 -Garage roof $1,600.00 Included -Install white circle vents along the soffit $350.00 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 King Inc. Total: $10,050.00-$500 Act Fast Coupon (Exp.9/30) $9,550.00 Deposit(due at signing): (1/3) $3,183.00 2" Payment(due when material is onsite): $0.00 Final payment(dueon job completion : (2/3) $6,366.00 SHINGLE COLOR: to t��—� r-<-Alnitial: O �- IJ 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 fees and court costs. Disclosure:Customer 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/Contractor, Property Owner Craig LaCrosse Mike Asselin ` The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 o- Boston,M4 02114®2017 www.mass.gov/dia «'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Libly Name (Business/OrganizatiorOndividual):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 any capacity.[No workers'comp.insurance required.] 9, ® Remodeling 9. ®Demolition 3. I am a homeowner 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.E]Plumbing repairs or additions 5Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.QRoof 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 a 14.®Other 152,§1(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 this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Star ' Policy#or Self-ins.Lic.#:WC 0742797 Expiration Date:_ gZ® I/ �_ Job Site Address: IJ (i f--e Q� C 4— City/State/Zip: /VC$-'4--, 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 and penalties of perjury that the information provided above is true and correct Signature: Date: 106 Phone#:978-580-7376 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#: CC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 3/13/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND C®FIFERS 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,thepolicy(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 endorsements). PRODUCER Risk Strategies Company NAME: Melissa Warren (781)986-4400 FAX o (781 15 Pacella Park Drive E-MAL )963-4420 Suite 240 Randolph MA 02368 INSURE S AFFORDING COVERAGE NAIC# INSURED INSURER A:SCottsdale Insurance Cc Junior T F Construction INSURERB:Guard Insurance Grou 406 Bridge Street INSURER C: #3 INSURER D: LOWel lINSURER E: MA 01850 NdsuRER F COVERAGES CERTIFICATE NUMBER:CL1531391061 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED D ABOVEEBFOR 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. ITR LTYPE OF INSURANCE POO C EFF PO Y EXP GENERAL LIABILITY POLICY NUMBEM R MLIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. A CLAIMS MADE OCCUR P91914893 /11/2015 /11/2016 PREMISES Eaoccu nce $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY PRO- LOC PRODUCTS-COMP/OP AGG S 2,000,000 AUTOMOBILE LIABILITY $ BI ED I E LI IT ANY AUTO Ea accident ALL OWNED SCHEDULED BODILY INJURY(Per person) S AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PPReOPPEER Y DAMAGE $ UMBRELLA UAB $ OCCUR EXCESS UAB CLAIMS-MADE EACH OCCURRENCE $ DED RETENTIONS AGGREGATE $ B WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC ST TU- OTH. ANY PROPRIETORIPARTNER/EXECUTIVE Y/N Y LI ITS ER OFFICER/MEMBERoryInN)EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ 100 000 (Mand describe and 2W627911 /11/2015 /11/2016 If es'descnbeuruler E.L DISEASE-EA EMPLOYE $ 100 000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VENICLES(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 Ring, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 12 Malvern Avenue Tyngaboro, MA 01879 AUTHORIZED REPRESENTATIVE Michael Christian/MSG '=� '— `�^ �ARD�25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(zotoos).o1 The ACORD name and logo are registered marks of ACORD AC<>wl CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD — I— (; Y TY s ;Is u !E CERTIFICATE H DER.MATTER INFORMATION � 2� N N AN CONFERS N RIGHTS PON C 0 IS To ONLY C 01"2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVE ERTIFICATE HOLDER. THIS INSURANCE DOES NOT CONSTITUTE T COVERAGE n �a�5a � THE POLICIES I RAGE A�FFORDED BY THE POL C ES BELOW. THIS CERTIFICATE OF_INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPOR`I,1111,11fl': lithe certificate holder is an ADDITIONAL INSURED,the policy(fes)must be endorsed. If SUBROGATION WAIVED, . A statement an this certificate does not confer rights to the the terms and conditions of the policy,certain policies may require an endorsement subject to I certificate holder in lieu of such endorsements. PRODUCER : McSweeney&Ricci Insurance Agency, Inc. PHONNAMEE FAX 420 Washington Street PC,NQ.Ext)181-848-8600 P.O. Box 850984ss:mrireo (A/C.Nol, 81- - Braintree MA 02185 INSURERS AFFORDING COVERAGE NAC# INSURED INSURERA; i Ci Roofing King Inc ROOFK-1 -INSURER B:Star Insur-ance Company Craig LaCrosse INSURERC: 4 PO Box 728 INSURER D: Tyngsboro MA 01879 INSURER E: COVERAGES INSURER F: CERTIFICATE NUMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 678720 1: i! f : ��:::�: REVISION NUMBER: INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR BEEN 1��l BELOW HAVE , ;;ElEl 1::: 1 TO 1 1:::NDITION OF ii:� ID NAMED ABOVE FOR THE POLICY PERIOD ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE fSSUED OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, INSR Y HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF ...... POLICY — POLIC EFF POLICY EXP INSURANCE GENERAL ILIA — MMID M D ANTS X Y Y CGL 0059562-21 12111/2014 12/11/2015 EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY D MAGE T RE TED $1 G00000 CLAIMS-MADE K OCCUR PREMISES(Ea occurrence) $100000 MED EXP(Any one rson $5000 PERSONAL&ADV INJURY $1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2000000 X POLICY T-'� LOC PRODUCTS-COMP/OP AGG $2000000 AUTOMOBILE LIABILITY Y $ M1T5776F 8/20/2015 8/20/2016 ANY AUTO (Ea accident) 1000000 ALL OWNED X SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED BODILY INJURY(Per acddent) $ AUTOS PRO ER MAGE -(Per dent)DA $ A UMBRELLA UAB xOCCUR CU0071022 12/11/2014 $ X EXCESS LIAB CLAIMS-MADE 12/11/2015 EACH OCCURRENCE $2G00000 DED RETENTION$ AGGREGATE $2,000,000 B WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N WC074279703 8/20/2015 8/20/2016 WC ANY PROPRIETOR/PARTNER/EXECUTIVE 5 OFFICER/MEMBER EXCLUDED? � N/A E.L.EACH ACCIDENT $500,000 (Mandatory In Ill U es,describe under E.L.DISEASE-EA EMPLOYE $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,N more space Is required) — Roofing(Commercial and residential)and siding ODerations. 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 PO Box 728 ACCORDANCE WITH THE POLICY PROVISIONS. Tyngsboro MA 01879 AUTHORIZED REPRESENTATIVE ACORD 25(2010/06) The ACORD name and to 1988-2010 ACORD CORPORATION. All rights reserved. go are registered marks of ACORD ()ff"cc of onslimerAtTairi& - ----- OMF CSFA-101415 PROVEMENT CONTFLACTOR Maistration: 171 117 Type: CRAIC A n: lal4/20 16 Pl)vzife C'flfonfaf( LACRGISSE 12 MALVERN AVE ROOFING KING!NC. TYNGS-SORO WA --RAIG LACROSSE 12 MALVERN AVS TYNI�SBORO, MA 01879 06/2512018 -W--r, Cro -'c j6 Y—f -g"