The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 10/20/2015 BUILDING NORTH 'L IN PERMIT OF 16 TOWN OF NORTH ANDOVER � � - _:<..:Y . APPLICATION FOR PLAN EXAMINATION $ Permit No#: Date Received c ISSgcHu5E4�� Date Issued: 1 IMPORTANT Applicant must complete all items on this page / / 1 rrr / / / r / /� / „ /i i /// rub a, ✓i//, d,/, „� ��ir,,� ,,,,�/r////��/�/i�,/,rr/%/��%/„oar/,r/% ,,,i//,r// /oi/iii/ /� / % /MaChlne� h0 ,�✓I�la e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building e family 0 Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial M'Rf 6pair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ;0 Septic //// Well //// ! r ,rr// /f❑ Flood lain ❑;Wetlands ripii driii�////✓/,.,,,c.�,�ii // / iii.. / h r,. , ❑ WaterShed';DIStrICt ,, a / DESCRIPTION OF WORK TO BE PERFORMED: Identificatio 1 se Type or Print Clearly OWNER: Name: 5 Phone: Address: 1� r � Law I / / � / / ce/// / i r / �I/int:raC %,„ r.�,,,1 ,, /,,:..., �/i//i: v��i rrr r � / r�� rr��'i...%/fir//% // /q / /i/r lr i. , /, / //,dr ss. d//,/r � .acrrn ri ,,// // / . ./i / / 1, ,. , / �/ervtsors Co s ,. �tr cI?,/ /// r / l r � // / li/ / � ////rne I .,m rouemen�Lt,,,,,a/v�i rlv,iP/////r/rroe, :;//r/?i ri/,i/UriUo 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: FEE: $ '7, Z, e1i Check No.: Receipt No.: �* NOTE: Persons contracting with unregistered contractors do not have access to the gua my fund Signature of Agent/Owner Signature of contractor FORTH -1"Ift ct o V e r V V ® ' �c Co h ver, Mass, coc.�'M..c. �1 ,®ADRATED S u BOARD OF HEALTH Food/Kitchen PER - IT T LLJ Septic System THIS CERTIFIES THAT ............. °`��..... ... �G.L�r................................................................... BUILDING INSPECTOR has permission to erect .......................... buildings on .. ...r 411A_c.(`.`_'x .!Y:t...................... Foundation Rough to be occupied as ........................ �°r .... ..11 �:. 'w..�................................................ 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 ES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONST RT Rough Service ............... .... ............ Final B61 6ING INSPECTOR GAS INSPECTOR 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. "s,-.. _,.. EXPRESS ROOFING - ESTABLISHED 1985 PROPOSAL DATE OF PROPOSAL IO/ 1� www.expressrootor.com mike ex reasr o co HOME IMPROVEMENT CONTRACTORS LICENSE#108126 P,C,sox 542,Chelmsford,MA 01824 CONSTRUCTION SUPERVISOR LICENCE 1199497 Phone:978-268-28301 Fax:978-251-2907 PROPp6AL SUBMITTED TO: .., :, ROOF COMPLETION DATE--.,._____.__.___._.___ SQ ` 1f1i4/el f41/k 61s4s YEAR HOUSE BUILT-1993 ora to a STRIP ALL ASPIJag SHINGLES OFF HOUSE-WINDOW-GARAGE ROOFS gLEAN UP AND HAUL AWAY TARP OFF HOUSE TO HELP PREVENT DAMAGE TO HOUSE AND LAWN AREA COMPLETELY DE-NAIL OLD ROOFING NAILS AND RE-NAIL ROOFING BOARDS AS NEEDED WITH 80RING-RII NAILS ALL WALL FLASHING WILL BE INSPECTED AND REPLACED AS NEEDED Install;Owens Corning Weather Look G Pro rade B ET a from the bottom eaves Owens Corning Weather Look G Prograde under chimney lead and down on roof Owens Corning Weather Look G Pro rade in valleys Owens Corning Weather Lock G Prograde ON ENTIRE BACK ROOM AND PORCHES LSO DORMER SECTION ROOF 'Oviins"Cornina Weather Look G Prograde around ven# I es on roof Owens Corning Weather Look G Prograde on roof where roof buts Into wails RhinoRoof S nthetio Roofing Underla ment over roof boards Owens Corning Starter striR on all roof decking edges Owens Corning Trudefinition Duration shingles We Install TI Per shingle for a 130 mph OC wind warrant Cut in 1 1/21"opening on peak of roof and install Owens Corning SureVent along all ridge surfaces(ridge vent is Hand Nailed Owens Corning ridge cag shingles Drip edge on all outside roof edges that do not have vented dri ed a white New Pipe flan c as over vent pipes 2"-4" All shin las will be fastened I 1 /q'- 1 '/"roofing nails BLOW OFF ENTIRE ROOF AND CLEAN GUTTERS AND DOWNSPOUTS ROLL,3 FOOT MAGNETS OUT TO PICK NAILS OFF LAWN AREA FOR FINAL CLEANUP INCLUDES: ALL LABOR AND MATERIALS FOR THE ABOVE AND ROOFING PERMIT VM Is— ALL ROOFING MATERIALS STRIPPED OFF YOUR ROOF WILL BE RECYCLED AT ROOF TOP RECYCLING l R LIMITED TY � L HAUL,`AWAY ALL SHINGLE Note!No warranty on problems and/or damaged caused by lea baokups No warranty on old skylights AM material is guaranteed to he as spacil/ed,and the work to be performed In accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: ; k " ANo MONEY OW PAYMENT IN FULL AT COMPLETION OF JOB WITH CASH OR BANK CHECK MADE OUT IN THE NAME OF Express Roofing INC. � Cell Tall Free Respectfully submitted Sisal 1-888-21 O-ROOF 0,00 Note,This proposal may W withdrawn by us it not accepted by! 1411412016 All workers fully Insured ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are.satisfactory and are hereby accepted. aro authorized to do fire work as specified.Payments will be made as outlined above.Any addit/oi wa th n the abov will b an extra charge, Signature Date C SHINGLE COLOR Nomoownoris resp nsibi for protecting and cleaning content ofatfic from possiblo dust and dabris during your roofing project, Not rosponsiblo for any issues caused by mold Any 1/2 In,Plywood Installation will be an additional charge of$64.44 PER SHEET Labor and materials included We recommend now chimney lead with all new roofs for an extra charge of$498.44 por chimney The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): A, L d Address: lu )QyNq rv\ City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.F�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 8. ®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 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure t contractors either have workers'compensation insurance or are sole 11.EJElectrical repairs or additions pro ' tors wi-all th no employees. 12.E]Plu repairs or additions 5. am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.21roof repairs These sub-contractors have employees and have workers'comp.insurance? 6Q 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#1 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: Am � Policy#or Self-ins.Lic.#: (`,(a aaL�s Expiration Date: / F 6 Job Site Address: + G/4YU2 City/State/Zip: /v. u j�'S t1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(fate). 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 th rn d penalties ofperjury that the information provided above is true and correct. Si ature: Date: Phone#: 7 it 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#: FATE(MMIDD/YYY'Y) ACORQ, I 41 312015 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). PRODUCERNTACT NAME: ANDRE SILVA 1103 Commonwealth Ave ADDRESS: ( ) _.. Rapo Jepsen Financial and Insurance Services is Nq a 508-87S-5600 ra Nw,508 875.5885 ADDRESSc Boston, MA 02215 INBURER(S)AFFORDING.__ ........ _ ._......... _ . _......._ COVERAGE NAIL M INSURER A: Essex Insurance Company INSURED CUAIJSA"ONS1`FtuCTION INS INSURER 8: AMGUARD INSURANCE CO 153 ARLINGTON ST APT 2 INSURER c FRAMINGHAM, MA 01702 INSURER o: INSURER E INSURE COVERAGES CERTIFICATE NUMBER: EXPRESS ROOFER REVISION NUMBER: THIS IS TO ERTIFY THAI`THE R5LICIE OF INSURANCE LIS C"ED-SK-0-WHIMBEE ISSUED TO THF INSURED NAMED ABOVE FOR THE POU Y PERIO 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 POLICYIEEFF "POLICY EXP` .._. _.. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMIOD/YYYY LIMITS GENERAL LIABILITY TBA 08/12/2016 03/1212018 EACH OCCURRENCE $.,. 1,0001000 "DAT/YAGC TO RNnN'T"ED" COMMERCIAL GENERAL LIABILITY PR�MISES..i.�e occurranco) 5... 100,000 1 CLAIMS-MADE I..,,X.,,.I OCCUR MED EXP(Any one person) $ 5,000 . A I PERSONAL&ADV INJURY $ l 000100 ........ GENERAL AGGREGATE $ 2 I OOI�w 00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUC'r6•CGMP/OP AGO $ 2,000,000 X I POLICY JPECRO-T LOC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY I a wCcldur�l $ . ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SOHEDLII.ED NON-OWNED PROPERTY"DAMAGE" AUTOS AUTOS BODILY INJURY(Per s------ nl) $ HIRED AUTOS AUTOS (per ercrldpnt $ _...... ... .. ..... _..-. _._w_._.._._ UMBRELLA LIAR OCCUR FACH OCCURRENCE $ EXCESS LIAR CLAIMS MAT>E AGGREGATE $ ....._ . .... _ ...__w_.,.. _..,_.-._.. __........ DFD RETENTION$ $ WORKERS COMPENSATION �. _. -°_- �.°_ _ AND EMPLOYERS'LIABILITY R2WC623453 01116/2'016 01/16/2010 _.... B OFFICER/MFMBER EXCLUDED? 7 N NIA EAC H,ACCIDENT $ 11 OOOOt� ANY PROPRIETORIPART`NER/EXECtiTIV t?L (Mandatory In NH) r i DISEASE EA EMPLOYEE $ 1,000,000 If yyws doscribe under ... .„ ...._......._.._.._... ..___.___., ..._... ES RIPTION OF OPERATIONS below E1,DISEASE POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101,Additional Remarks Schodulo,If more apace Is required) CERTIFICATE HOLDER. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C CELLED BEFO THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELI RED IN ACCORDANCE WITH THE POLICY PROVISIONS. EXPRESS ROOFER AUTHORIZED REPRESENTATIVE mike@expressroofer.com 16 JONAS RD WE TFORD, MA 01886 01988«2010 A OFi ORPOR TION. All rights reserved. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD iaaa hueetta -Department of Public Safety Board of Building Regulations and Standards f:`owar rtion Superii- ,r Slaa.ch lrw Lieenm CSSL-099497 MICHAEL L COR, 16 Jonas Road 7Westford NIA 01986 Eplration C omni si on er 04/24/2016 ''"'%w "f�r,rtrxr�c-ra�thcri✓1"�r '�'��rsfrrr✓rrre// Office of Consumer Affairs&Busi ess Regulation SOME IMPROVEMENT CONTRACTOR registration: 108126 Type: expiration: 8/13/2016 DBA MICHAEL L.CORTNER-EXPRESS ROOFING Michael Cortner 16 JONAS RD .__--- WESTFORD, MA 01886 undersecretary i i