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HomeMy WebLinkAboutBuilding Permit # 10/23/2015 BUILDING PERMIT No�TH A. O��.cLED l6 q•�O TOWN OF NORTHA V �� y� 46 ® APPLICATION FOR PLAN EXAMINATION Date Received Permit IVo#: S US Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION J int PROPERTY OWNER � Print 100 Year Structure yes ne MAP PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes n,o,-,�' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑ALeation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other L NDAlll(Yll//Ii 6X,9Y4u«�l IU,✓yA�iZ�IGf,nJJ%�, .a..�r � !!!I,r ;.� I,,R,,1�,;'�.�;".NY),p/0,.?f1�.rUl�. fW1.`�'P�kVYi��`if. r YR,..,%Glllr"IGr JP,I�INN�/Y;,..(�ii�,/�'lf�/i/�,�,��,/��r.p� ... r DE " SC IPTION OF WORK TO BE PERFORMED: dentcation- PI e e Type or Print Clearly OWNER: Name: Pho ..� Address: cam° . Contractor Nam �L � " 6 g&j Phone: Email: Address: r 2 Supervisor's Construction Licens '7 �o Exp. Date: Home Improvement License: ' Exp. Dater " ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 F THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 14;-° 76 , FEE: $_ A Check No.: Receipt No.: .,;)—i '1�7� NOTE: Persons contracting with unregistered contractors do not have access to uaranty fund %i-- NORTH Town of ndover No. _ y U O LAKF h ver, Mass, . lb <<j COCKICHFWICM �� A�RgTEcoo S V BOARD OF HEALTH Food/Kitchen P,�E ERNENlh' T L D Septic System THIS CERTIFIES THAT ....... ff � BUILDING INSPECTOR ............ ..........� C!�5....................... .....................:............. _ ... has permission to erect buildings on (` Foundation Rough to be occupied as ........ .. ...��r ... ................................................................................ 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 EXPIRES IN 6 MONTHS ELECTRICALINSPECTOR UNLESS CONSTRUCT N STARTS Rough Service ............ . ................................................ Final BUILDING 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 Approved by the Building Inspector. Burner Street No. Smoke Det. Proposal b ) HIC#174377 Damphousse Rodl.I .I m SLP A trusted name since 1938 Roofing ® Siding -Windows i^3 V 67 Belmont Street- North Andover, MA 01845 P: 978-683-4586 F: 970-635-7446 NAME OF OWNER ADRESS OF JOB ~' DATE: TEL. 33 We will remove all roof shingles off total roof area, layer. Replace any boards or sheathing at additional cost. A new 8" white aluminum drip edge applied on all edges.Approx. 6ft of ice and water membrane applied on eaves, 3ft in valleys, strips around skylights, along chimney flashing and sidewall junctions. Existing step flashings to remain. A new base sheet applied. Architectural roof shingle installed with a limited lifetime warranty. Install new ventpipe boot flashings. Waterproof existing chimney flashing and remove debris. Shingle C ' l 011 Ridq e Vent Upgrade =;VI Wood Sheathing Repair$3.50 per ft. I i We Propose herby to furnish material and labor-complete in accordance with above specifications,for the m of: dollars ) Payment to be mas f ows C� Authrized Signature NOTE:This proposal may be withdrawn by u not accepted with in days Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are herby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature Date of Acceptance: �_ Signature HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS(M.G.L.142A) 1.WORK:Provided the Homeowner performs under this agreement,the Contractor shall perform the work on the Property as specified Proposal,attached incorporated herein.The work does not include extraordinary conditions of which the Contractor could not reasonably be aware.If such conditions are encountered,this shall be an additional cost to the Homeowner.Materials selected by Homeowner may have to be ordered or custom made,which items are specified in the Proposal.The Contractor is not obligated to agree to any modifications,extras or change orders unless such items are agreed to in writing by the Contractor.All extras and changes shall be at an additional cost to the Homeowner.Contractor shall perform the work in a good and workmanlike manner using materials consistent with this contract.Lawn or Driveway may be damaged by dumpster or equipment.Due to material shortages Contractor may substitute materials of equivalent grade. 2. PERMITS:If a building permit is required for the work,the Contractor shall obtain same as Homeowner's agent.Contractor is not responsible for any other permits that may be required for the Work,and Homeowner is responsible to determine whether any zoning,planning or wetland related permits or approvals are necessary.Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund. 3. COMMENCEMENT AND COMPLETION:Homeowner acknowledges the commencement date of the work is fluid,and is subject to numerous factors such as scheduling other contractors,delivery of materials and weather.Contractor and Homeowner shall determine the commencement date of the Work when a more definite determination can be made and shall execute a written acknowledgment of same.The Work shall be substantially completed within 7 days of commencement,except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal,and subject to delays for circumstances beyond Contractors control.Notwithstanding,the commencement date and substantial completion date may be extended,and the Contractor will not be liable for delays caused by,labor or material shortages,delays in delivery of items selected by the Homeowner,governmental action, and unforeseen events beyond the Contractor's control,including but not limited to weather,strikes,war,the acts of third persons or the acts of the Homeowner.The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractor's other jobs. 4. PAYMENTS:Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the Proposal.Thirty percent(30%)of the total is to be paid as a deposit with the signing of this contract.Upon cancellation prior to commencement of the Work,any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel.Final payment shall be due upon completion of the Work and Homeowner agrees it may not hold any retainage.Late fees may be applied for late payments.Homeowner shall pay Contractor's reasonable costs of collection,including attorney's fees and costs.Time is of the essence hereof. 5. WARRANTY:For a period of 1 year after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship, but not those caused by ice backing-up or extraordinary weather events,including blizzards,tornadoes,hurricanes or storms of greater than a twenty-five year duration or intensity.Contractor gives no warranties with reference to any materials or equipment installed in the Premises,passes any such warranties directly to Homeowner,and Homeowner agrees to look only to the manufacturer with reference thereto.This limited warranty extends to the Homeowner only and is not transferable to succeeding Homeowner's.This Limited Warranty specifically excludes(i)all consequential and incidental damages;(ii) damage due to ordinary wear and tear,abusive use,misuse,or lack of proper maintenance;(iii)defects which are the result of characteristics common to materials used;(iv)defects in items installed or supplied by anyone other than Contractor;(v)work done by anyone other than by Contractor;and(vi)loss or injury due to the elements.There are no other expressed or implied warranties or representations made or given. 6. ENTIRE AGREEMENT:This contract and all documents referenced herein constitute the complete and final agreement between the parties.In the event that any of the provisions of this contract shall be held to be invalid,the remainder of the provisions of this contract shall remain in full force and effect.Two identical copies of this contract have been completed and signed.Homeowner acknowledges receipt of a completed contract signed by the Contractor. 7. HOME IMPROVEMENT REGISTRATION:In accordance with M.G.L.c. 142 A,§9,Contractor is registered with the Bureau of Building Regulations and Standards Registration No: 174377.Homeowner may verify by contacting the Director at(617)727-3200,ext.25205.A Homeowner's rights under the Home Improvement Law(M.G.L.c. 142A)and other consumer protection laws may not be waived in any way.Homeowner acknowledges receipt of a copy of 780 CMR R6 and Massachusetts General Laws chapter 142A,and which are available online at www.mass.gov.Questions may be directed to the Consumer Information Hotline,(617)727-7780. 8. ARBITRATION:Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 142A.No lien or security interest is imposed on the Property as a consequence of this contract,but Contractor has the right to record this contract or a notice of this contract,or seek a lien if the Homeowner breaches this Contract. 9. HOMEOWNER COVENANTS:The Homeowner agrees,represents and warrants that(a)the Homeowner grants permission to the Contractor to enter the Property to perform the work as covered by this contract;(b)the Homeowner has funds available to make full payment under this contract to the Contractor upon completion;(c)the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition,and agrees not to enter portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed;(d)Contractor may need use landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and(e)that code requirements may result in nd holds roofing nails penetrating through roof decking and will be visible on the underside of some surfaces.The Homeowner indemnifies,exonerates a harmless the Contractor from any loss,damage,claim,liability or expense(including reasonable attorney's fees,deposition costs and court costs)resulting from a breach of this provision.Contractor is not responsible for damage to landscaping that will grow back during the next growing season. 10.CANCELLATION:Homeowner may cancel this agreeme t provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not later than midnight of the third burin 's day folio ing s' ing of is agreement. '` HOMEOWNER: „. � DATE:_ DEPOSIT: ✓ — Shingle:__,,,, " The Conunoitwealth of111assaclursetts Del)ar'irnent of-In dlistrial Accidents Office ofluvestigations 600 Tf,ashington Street Boston, _I1fA 02111 tvinw.niassgov/dia Workers' CorrlpensatioD Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant TnConnation Please Print Lel4ibly Name usiness/0rganizalion/Individual Address: City/State/Zi /W_ Phone# Are you n employer? Check th'e'approHate box: Type of project(required): 1.E14 am a employer.with 4. ❑ I am a general contractor and I employees (full and/orparl-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attacbcd sbeeL t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their .10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plu ing repairs or additions myself [No workers' camp, c. 152, §1(4), and we have no 12, oof repairs insurance required.] t employees. [No workers' ' comp. insurance required.] 13•❑ Other *Any applicant that checks box#t must also E-11 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 tContraclors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy iri£orrnadon. I am an employer that is proNding raor'kers'compensation insurance for my employees. Below is the policy and job site inforrnalion. Insurance Company Nam ' Policy#or Self-ins. Lie.MAIL, ,, e° „ ° g�+ iration Date: "- Job Site Address: City/Stale/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 Section 25A of MGL c. 152 can lead to the imposition ofcruninal penalties of a Cine up to$1,500.00 and/or one-year iinprisomnent, 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veriricalion. Ido hereby cer7ifj�un r tr e pain's at enalties of perjcrt),that the information provided above is true and correct S izaa ture: �~ Dale: Phone#: 'Official use only. Do not write in this area,to be completed by cif)or toidn offciaL City or Town: Perrnit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Tbwn Clerk 4.Electrical Inspector 5..Pluutbing Inspector 6..0th,er Contact P erson: Phone#: 4 7 /2015 11 : 05 : 02 AM 8790 ® 02/02 r DATE(MMIDO/YYYY) ,SCO CERTIFICATE OF LIABILITY INSURANCE 0411 7/2 01 5 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 pol)cy(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). N PRODUCER 00474-001 NAMEACT Doherty Insurance Agency Inc (AlCNNo.Ext): (978)475-0260 (INC,No.: PO Box 1985 EMAIL Andover,MA 01810 ADESS: INSURERS)AFFORDING COVERAGE NAIC t INSURERA: A.I.M.Mutual Insurance Company 33758 INSURED Damphousse Roofing LLP wsuRERe: INSURER C: 87 Belmont Street North Andover, MA 01845 INSURERD: INSURERE: 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.LRIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSR U D POLICY NUMBER MMIDD/YYYY PMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY OAI�WGE TO RENTED $ '.. PREMISES Ea occurrence CLAMS-MADE [:]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ '.. GENERAL AGGREGATE $ '.. EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ OLICI' F CT OC j AUTOMOBILE LIABILITY COM8INED SINGLE LIMIT $ Ea accident' ANYAUTO BODILY IN URY(Per person) $ ALL OVMEO SCHEDULED BODILY INJJRY(Per accident) $ AUTOS AUTOS '.... HIP.EDA.UTOS NON-OVMED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAPAS MADE AGGREGATE $ ''.. DEED RETENTION $ gTT $ AND EM PLOYERSELIABILIITY X TORY lIMIT5 ER ANY PROPRIETORPART�lERlEXECUTIVE Y IN E.L.EACH ACCIDENT $ 500,000.00 /{ OFFICERlFdEMBER EYCL D D9 NIA AWC-400-7028774-2015A 4/17/2015 4/17/2016 (Mandatory InNH) EL DISEASE-EA EMPLOYEE $ 500,000.00 OEY '.. SCRON UO� OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 I LJ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,Ir more space is required) No partners are covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 6913 Client#: 14415 DAMPHOl1SSE A R_ CERTIFICATE F LIABILITY INSURANCE 04/17/2016 M PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street Andover,MA 01810 INSURERS AFFORDING COVERAGE MAIC# INSURED INSURER A: Western World Damphousse Roofing LLP INSURER B 87 Belmont St INSURER C: North Andover,MA 01845 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR g TYPE OF INSURANCE POLICY NUMBEfl POLICY EFFECTIVE POLICY EXPIRATION DATEIMMIDONYI, DATELIMITS A GENERALLIABILITY NPP8202847 04/12/15 04/12/16 EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 CLAIMS MADE Q OCCUR MED EXP(Any one person) S5,000 PERSONAL 8 ADV INJURY 51,000,000 GENERAL AGGREGATE $2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGG s2,000,000 X POLICY PEC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea aceidenl) $ ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Perperson) S HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Por accideni) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION S S WORKERS COMPENSATION AND WC STATU 0TH. EMPLOYERS'LIABILITY ANY PROPRIETO"ARTNERIEXECUTIVE E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 11 os.doscribo under '.. SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIV AUTMORQED AESENT TIYE ACORD 25(2001/08)1 Of 2 #S31838JM31835 DML 0 RD CORPORATION 1988 CS-067560 SHAUN M TWOA'IEY 61 PATROIT ST N ANDOVER MA 0184 1012512015 CS-055108 DOUGLAS J LEGARE -- __- 79 GARY AVE HAVERHILL MA 01330 09/0212016 - — //I .✓��avftcc�uaelta Office of Consumer Affairs&B smess Regulation HOME IMPROVEMENT CONTRACTOR Type: Ii Registration: 174377 U Expiration: 2/4/2017 LLP DAMPHOUSSE ROOFING LLP SHAUN TWOMEY 87 BELMONT ST �� - c— N.ANDOVER,MA 01845 Undersecretary