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Home My WebLink AboutBuilding Permit # 10/7/2015 OORTH BUILDING PERMIT 0�eo 16 -'h. 6 TOWN OF NORTH ANDOVER io APPLICATION FOR PLAN EXAMINATION Z, 7. Date Received RATED Permit No#: 's Date Issued: IMPORTANT:Applicant must complete all items on this page F LOCATION r Print PROPERTY OWNER LJCJ C :—E�2 S/0 L") Print loo Year structure yes no ZONING DISTRICT: Historic District yes no MAP PARCEL: —Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential El New Building [I One family [I Industrial [I Addition [I Two or more family [i Commercial W)Alteration No. of units: El Repair, replacement El Assessory Bldg El Others: 0 Demolition El Other Well................. DESCRIPTION OF WORK TO BE pt:KrORIVIED: Pe ,Identificatin� Pleas�Type or Print Clearly Phone: OWNER: Name:— Address: e: Phone: 6/ m Contractor ontractor Nam Email: ———— 77 Z-��Jc, Address-- S up .-Exp. Date: Supervisor's Construction License:_ S or Exp. Date: I rHome, Improvement License: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: C FEE: Check No.: 2—Me — NOTE: Persons contracting with unregisteredReceipt c retractors to ccess to the guaranty fund ------------- wfte t%ORTH Town ofndover 0 . 3 y q6► 640 �p twit@C Oil 9 s5, A_ COCNICM@WICK%y,I. 7®Q�RwTEO ® ,�� S U BOARD OF HEALTH T Food/Kitchen PER L LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............ ..... .... ................. .. .�'�... .>k�..... ................................................ . Foundation has permission to erect .......................... Ildings on ......... ..... ►�r''� • Rough to be occupied as . {/t .................................................................. chimney provided that the person accepting 1his 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES I T S ELECTRICAL INSPECTOR LESS CONSTRUCTION Rough . Service ................. ............ Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required t® Occupy PuildinRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or all ToBe Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. CD Roofing Vincent Colangelo 3 Hodgson St. Tewksbury, Ma 01876 978-656-8497 vincentcolangelo@sbcglobal.net HIC Lic# 170575 r �} 7 /, CSSL Lic# 105943 r, Customer: 1%� 5L)"41 e, s OENS CORNING . An dove C6 � _ �- �t1A PREFERRED O Description of work Performed: 47f A 6 5`6- 60c`7 Obtain required town permits & provide certificates of insurance&workers compensation rovide Dumpster set on planks*for contractors use only(materials all recycled) Attach Large Tarps to protect adjacent finishes, landscaping, and property. trip-off( ( ) existing layers of roofing on complete house& re-nail any loose decking Install flinch Aluminum Drip edging /Owens Corning Starter Shingles `(Install Owens Corning Ice&Water shield 6ft at eaves, 3ft in valleys, around all penetrations 'g Install Synthetic felt paper to entire roof ,tom,Install Owens Corning LifeTime warranty TruDefinition Duration shingles Install new neoprene vent pipe flashings on all plumbing pipes nstall Owens Corning VentSure ridge venting with moisture guard C* Vo VF c$'algr-- Pct.,I Install Owens Corning ProEdge'hip& ridge cap shingles Completely re-flash chimney with lead Owens Corning Preferred contractor installation with full warranty 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 clean the job site, and use a magnet roller to collect scattered nails. Additional work to be performed 'n s 1l G So (a r A 44-,'& Fcf All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications must be made in writing on an Add-on/Moditication 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 ether 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 homeowner defaults, porneowner 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 move specifications, for the sum of: dollars ($ (,Vl f � - ). Said amount shall be paid as follows: f Note:This proposal may be withdrawn by us if not accepted within 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 OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. Work will not begin until your right to cancel has expired and you h d o 't of dollars($ ), unless this agreement provides Signature of Contractor or authorized representative: *(VWe)have read the terms stated IWrein,they hav been explained to(me/us),and (I/We)find them to be satisfactory and hereby accept them. Signature of Homeowner(s):____ j{N 1 The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.govIdia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FMED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib NaMe (Business/Organization/Individual): ��'�� ( � �'l�1C�Pi V Address: City/State/Zip: Phone#: C773—��(� Are you an employer?Check the appropriate box: Type of project(required): L❑I am.a employer with employees(full and/or part-time).* 7. ❑Now construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodelirig any capacity.[No workers'comp.insurance required.] 3.C]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I w 10 []Building addition ill ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees, 12.0 Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its of�cers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have nq 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. Homeowners who subniif 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-contractors have employees,'diey must provide their workeis'comp.policy number.' -tam an employer•that is pi oviding ivorkers'compensation insurance for•my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie.#; � , `c'u��`j Expiration Date: Job Site Address: W6 5 u,i1/i.-e-r 54- City/State/Zip: 1V_ A -1/0 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 atement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido leer eby cer tify�a ae pains n penalties fuerjury that the information provided above is true and correct �/ i _ Si nature: 4 7 Date: "O b 11,5 Phone Official use only. Do not write in this area,to he completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/`t'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ® CERTIFICATEI DATE( /DW"YY") 4/23/15 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(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 endorsenent(s). PRODUCER CONTACT NAME: Angela Westen Insurance Agency PHONE , (978) 735-4094 1FAM No: (978) 735-4095 557 Central Street ADDRESS: angela@awesten.com Lowell, MA 01852 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A-ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B: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 I WVD POLICY NUMBER M/DDN WmlaryYYY LIMITS A GENERAL LIABILITY L021008696 3/18/15 3/18/16 EACHOCCURRENCE $ 1,000,000 $ COMMNTED ERCIALGENEPAL LIABILITY DAMAGE (Eaoccurrence)e ce) $ 100,000 CLAIMS-MADE D OCCUR MED EXP(Any one person) $ 5 000 PERSO NAL&ADV INJURY $ :L,000,000 GENERAL AGGREGATE $ 2,000,000 GENTAGGREGATE LIMITAPPLIES PER PRODUCTS-COMPIOPAGG $ 1 000 000 POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE L IMIT a accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per aocidenl) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _AUTOS $ UMBRELLA LIAB OCCUR EACHOCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 2E112068 3/30/15 3/30/16 �^/CSTATU- oTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE 7 N/A E.L.EACHACCIDENr $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1Q0 r 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if morespace is required) 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 HO DGSON ST. AUTHORIZED REPRESENTATIVE TEWKSBURY, MA 0187,6 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: VINCENTCOLANGELO@SBCGLOBAL.NET ;V?assachusetts - C)C-P' rLm DC-P' e ? S afa y° 1 'Oarrd of Building led tun nar s License: CSSL-105943 ` _f VINCENT COLANGELO 3 HODGSON STREET' Tewksbury NIA 01876 - Ccmir + Y t '�' 03/09/2016,, ' axee�w»so:zc�ea a 'C% z�cccuaeC�� Office of Consumer Affairs& Business Regulation - ME IMPROVEMENT CONTRACTOR egistration: 170575 Type: xpiration 11/f0120I- : DBA CD ROOFING VINCENT COLANGELO - 3 HODGSON ST TEWKSBURY, MA 01876 Undersecretary l Al { 3 r,