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HomeMy WebLinkAboutBuilding Permit # 10/7/2015 i %AORTy BUILDING PERMIT o��iLED 'b 6 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION �- Rq i1 Permit No#: % �'/ Date Received ��ss�cHus���5 Date Issued: � IMPORTANT:Applicant must complete all items on this page LOCATION Cp ( t `� Print PROPERTY OWNERCA 1 Print 100 Yea7Shop yes no MAP PARCEL: t ZONING DISTRICT: Historiyes no Machiillage yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑-New Building ❑ One family El Addition [I Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Se tic ❑1Nell Floodplain D Wetlands ❑ Ul/atershed Distract a F p r %� ;vr �f �` y "i .. J r� z /r r r -" �� `vr "o,1N,ater%S,ewer. DESCRIPTION OF WORK TO BE PERFORMED: IdentIrtion- Please'hype or Print Clearly OWNER: Name: t, ( I� c Phone: ? 5 v ` rt Address: -3 Contractor Name: Phone: C(? 6S-6 " `/2 Email: Address: '3 cl Supervisor's Construction License: 10�-q t Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 01 X06 FEE: $ " Check No.: Receipt 2 9L[ NOTE: Persons contracting with unregistered conractors aess to the guarantyfund nd t%ORTH -rown of liduver Z h ver, ass, OLAKE COCNICNCW/CK �®ADRHTED PPa�,t5 111111111111111k �� RMIT T D 7S U BOARD OF HEALTH Food/Kitchen r E Septic System c BUILDING INSPECTOR THIS CERTIFIES THAT ........................................J ................................ ..................................... . 1 has permission to erect buildings on ... �11�St.. � .Y. li. ,......,,,, Foundation .......................... ... ..... .... fQ Rough tobe occupied as ........... .�......... ....1..G.. ,.................................................................... Chimney provided that the person acceptingthis ermit shall in eve res ect conform to the terms of the a lication p p p rY 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESSCONSTRUCTION S RTS Rough Service ............... ........ ...0.,�Q'. . ... .. . ,................... Final ,�c� UILDING INSPECTOR GAS INSPECTOR Occupancy 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 Approved by the Building Inspector® Burner Street No. Smoke Det. CD Roofing Vincent Colangelo 3 Hodgson St. Roofing Tewksbury,Ma 01876 THERE'S NO ROOFWE CAN'TCOVER 978-656-8497 -ft 9vincentcolangelo@sbcglobal.net -84 'k 7 HIC Lic# 170575 CSSL Lic# 105943 5 6, Customer, OWENS CORNING G, q PtIllif' ,AlPS CAW q.?9,-85-2 q78`( PREFERRED CONTRACTOR A)� Ailldu Ler q,78-6ts-_ kms Description of work Performed: (Obtain required town permits& provide certificates of insurance&workers compensation Provide Dumpster set on planks*for contractors use only(materials all recycled) Attach Large Tarps to protect adjacent finishes, landscaping, and property. Strip-off( I ) existing layers of roofing on complete house& re-nail any loose decking Install flinch ij,)tlijj Aluminum Drip edging/Owens Corning Starter Shingles Install Owens Corning Ice&Water shield Eft at eaves, aft in valleys,around all penetrations Install Synthetic felt paper to entire roof Install Owens Corning LifeTime warranty TruDefinition Duration shingles Install new neoprene vent pipe flashings on all plumbing pipes Install Owens Corning VentSure ridge venting with moisture guard Install Owens Corning ProEdge hip&ridge cap shingles KP ComoetelyPp ;tsh-e"mnW_with ISad— Owens Corning Preferred contractor installation with full warranty re-pa)r bbte_ reA*- "O� OvI 4-avv+ All work will be completed according to state and manufacturing codes and specifications. Every day we will have the roof water tight, clean gutters, completely c an the j lb site, and use a magnet roller to collect scattered nails. Additional work to be performed o+ "`ref 0-4 apt aDU6­0 Oki qe 9p, wo04 64vw erm A*Vs 4eeJ4�e .,, do L fmp i/ or)' (A-) , A 0,04 ex4-yo'. f OL.s ZV.e C�4 a t/,e hobat� All material is guaranteed to be as specified. All work to be coApl6ted in a workmanlike manner according to standard praitices. Any alteratior#or deviation from the he above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the horneowner defaults, homeowner agrees to pay all costs of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of: dollars ($ to , 800. '0 ). Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within 6,6 —days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF---THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE Or'_`CANCEj4�TION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS 0 0 ME SOLICI ATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. 6,C Work will not begin un r right to cancel has expired and paid e- osit of dollars($ C)�)006 V011), unless this agreement provi s wise: Signature of Contractor or authorized representative: y *(I/We)have read the terms stated herei -,t y have been e�0ained to(me/us),and (I fi r`f`them to be satisfactory and hereby accept them. Signature of Homeowner(s): ;Z7 The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,AM 021142017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TEE PERMITTING AUTHORITY. Applicant Information Please Print LcOb Name (Business/Organization/Individual):� yCQ�►��1 Address: ��� Sc�� t City/State/Zip: Phone#: e� 26 5_( -�V�l-2 Areyou an employer?Checkthe appropriate box: Type of project()required): 1.❑I am a employer with employees(full and/or part-time).* 7. El New construction 2.[J I am a sole proprietor or partnership and have no employees working for me in $, F]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 Building addition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5. I am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs J These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q 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. i Homeowners who submit this 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-conhacfors have employees,&y must provide their workeis'comp.policy number. I am an employer•that is providing workers'compensation insurance for•my employees.'Below is thepolicy andjob site information. / Insurance Company Name:_ n t _I rExpiration Policy#or Self-ins,Lie.#: L i;%Ar I(7b� C�v Date: Job Site Address: G r•Cf"R�; City/State/Zip: 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 foe 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. !do hereby cert' u.9der thep4ho andpenalties ofperjury that the information provided above is true and correct. . Date:�� --�' Si nature: Phone#• eii-2!6 S k a 1 2 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#: DATE(MM/DD(YYYY) ACC>RDO CERTIFICATE OF LIABILITY INSURANCE 4/23/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TFJS 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 ADDIT10NAL INSURED, the policy(les) 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: Angela Westen Insurance Agency PHONE Fax 735-4095 • (978) 735-4094 No: (978) 557 Central Street E-MAIL ADDRESS: angela@awesten.com Lowell, MA 01852 INSURE S AFFORDING COVERAGE NAIC R INSURER A:ATLANTIC CASUALTY INSURANCE CO INSURED INSURER IS:HARTFORD UNDERWRITERS INS COMP FO CONSTRUCTION CORP. INSURER C: 40 READ ST. INSURER D: LOWELL, MA 01850 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/WN MM/DD/YYYY LIMITS A GENERAL LIABILITY L021008696 3/18/15 3/18/16 EACH OCCURRENCE $ 11 00,000 X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISES( RENTED $ 100,000 CLAIMS-MADE F-1 OCCUR MED EXP(Arty one person) $ Cj 000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-DD MP/OPAGG $ 1,000,000 17 POLICY PRO- 1-1 LOC $ AUTOMOBILE LIABILITY COT ,deEDUSiNGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS .,accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 2E112068 3/30/15 3/30/16 WC$TATO- 0TH- AND EMPLOYERS'LIABILITYT. Y FR ANY PROPRIETOR/PARTNER/EXECUTNE 7 N/A E.L.EACHACaDEN1r $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes,describe under DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rena rks Schedule,if more space is requi red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CD ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. VINCENT COLANGELO 3 HODGSON ST. AUTHORIZEDREPRESENTATNE TEWKSBURY, MA 01876 F ©1988-2090 ACORD CORPORATION. All rights reserved. ACORD 25( ) --- The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: VINCENTCOLANGELO@SBCGLOBAL.NET �r. Ms-efts Dep rte t -. &! Bu. dsf g * �_ aid �� �d t � u _ . CSSL-105943 VINCENT CO GES. O N_S ]�T Tewksbury j 43876 Explrati. 0310312016" Office of Consumer Affairs&Business Rebulati€n TME IMPROVEMENT CONTRACTOR M%elgistration: 17{} 76 Type: piratian DBA CD ROOFING = VINCENT COLANGEL© _ 3 HODGSON ST = G t TEWKSBURY, MA 01876 Undersecretary k j