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HomeMy WebLinkAboutBuilding Permit # 10/26/2015 %•FORTH BUILDING IT O� TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION - q n /' b Kermit No: Date Received .0., $J`.vATeb 5 i Date Issued: ) S CHu EVYPORTANT:Applicant must cam tete all items on this page IOCATIOI F'ROPERT ►wn� R � � �� NIAP �O"' P�RC�l° ' ���tJNI IG �ISTPIOT �HMstOn Distr"rct no .. , , Maeh'ir► Shap'Villa yep rjo TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family I I Addition I I Two or more family zornmercial dustrial 11 Alteration No. of units: epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Q'S'eptic "-❑"W II ❑ Floodptalri 11 Wetlands ❑ Watershed District Q Water/Sewer, / /1, Identification Please Type or Print Clearly) OWNER: Name: oc ... Phone: 4._ Address: 05 6 0 6') 0f-iii A").2069- pl NTRAOTSR Narne _ Phcarae AdreW �„ uperuxor' o,"n""""''s7. '"""U" rys Exp; Date: - M4��e E 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: $ azo . FEE: $ l Check No.: 7t??D� Receipt No.: 42,9 I NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund Signature of Agent/Owner Signature of contractor _ tkORTH town of ' lictover 1 ® - to • 4— T h Py� X15 O LAKE � VVY' `ASS' COCKIc NEWICK S U BOARD OF HEALTH Food/Kitchen PE �RMIT D Septic System THIS CERTIFIES THAT ....... OR' V�p ��+� BUILDING INSPECTOR ......... ....................................................................w! ......`.. .. Foundation has permission to erect .......................... buildings on _15.1.94....%... .64... .. . . ......./�� Rough to be occupied as .. .. .... ... .. ......t..:VM�!1.. .. b...lown.240�. '........................ Chimney provided that the person acctting this permit shall in every respl5ct 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 ELECTRICAL INSPECTOR UNLESS I T RTS Rough Service ............. .... .. . .................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® OccupyBuildin 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. Old School Roofing ® 297 Littleton Rd ® Chelmsford, MA 01824 00 978-251-7663 (Office) 978-251-7664 (Fax) ® a www.old'schoolgro-Lip.com (,(-)N I'INUALLY T AIbTED AND CERTIFIED BY AMERI-C—A'S I RCxEST RO®FIN ALU-4 F!C I LJRE_ Edgewood Retirement Community S Proposal September 11, 2015 575 Osgood Street North Andover, MA 01845-1935 Phone: (978) 725-3300 Attn: Bob Copolla 1. Job Specifications: Buildings 1000 and 2000(including rubber porch roofs on Bldg 1000) 2. Job Preparation: *Set up job site and insure attention to your particular concerns. Installing tarps around the areas being worked on to prevent damage to siding, plantings and any landscaping. 3. Remove Old Roof. *We will remove the existing layer of roofing. This allows for inspection of the roof decking,and repair any damaged boards. MOTE: We will replace any damaged or rotted plywood at $2.00 per square foot for'/Z CDD plywood, $2.25 for 513 CDX plywood and$3.00 per lineal foot for deck boards 4. Install Leak Barrier. *Install full cover ice and water barrier. *This for extra protection against"ice damming"-as recommended by manufacturers, 3' of hi-temperature ice and water shield feet up the valleys underneath the new copper valleys. 5. Flashing Details. *Install new 8"aluminum drip edge to all rakes and eaves,and pipe flashings.All side walls will be removed and ice and water installed with new step flashings. 6 Shingle Application: Antall a Lifetime Architectural Shingle,CertainTeed Landmarke Colonial Slate. 7. Ventilation: *Install a new ridge vent on all dormers. We use a ridged vinyl baffle vent which allows for the best ridge ventilation. 8. Hip&Ridge Shingles: *Install new hip and cap shingles, this provides protection of the ridge vent and a finished look to the roof line. 9. Roof Warranty. ♦Limited Lifetime Manufactures Warranty.(40yrs Commercial) 10 Year Workmanship. 10. Clean-up/Disposab *Old School Roofing supplies the dumpster.Our disposal costs are based on recycling of the asphalt shingles. Please do not throw any household trash or foreign materials into the dumpster. We will thoroughly clean up and dispose of all materials and debris associated with the job. Vrotection and clean-up of the prop V are One of ogr blrgest co:�cerns. 11. Permits: *Old School Roofing will be responsible for obtaining any and all necessary permits to insure the work is performed legally. 1 y i' Scheduling. *We do our best to stay within stated scheduling, estimated lob completion 1244 days. However, Mother Nature and emergencies can lead to delays. We will do our best to limit those delays. We will contact you within 48 hours before installing your new roof and work will not be commenced until you are contacted first. If more time is necessary to accommodate your schedule,kindly let us know. .lob Cost $99,420.00 Payments shall be made as follows: %deposit due before scheduling work, balance due upon completion of the work. QUOTE GOOD FOR 10 DAYS ONLY. All a�plicaiale czisec�tfs Iiea. SICN4�1INDICATES ACC PT C OF THE PC AND SP CI IC.ATIONS S T FORTH Ind.AND ACCEPTANCE CF T e S AND CC ITIO S CF THIS CCNU CT. Old Sfing: n Prope�M4 Manager: Date �� a,,&-Date Authoriz presentative ANmbbernorch roofs wi//be done with 060 EPDM adhered to y2 Insulation Board Additional Worklncluded.- Removing siding on dormers to instal/ice and water shie/d and newstep flashings Ifnewsidinq needed an addition/cost would app/v fu//inspection of the main mbber roof. Too include.•Inspection ofa//penetrations(approx 74)clean and seal anv/iftina seams Inspection of all rubber/aps/ioints clean andsea/as needed Any serious issues discovered wi/l be written up and discussed prior to any workstarted. Please feel five to call me with any questions Thank you. TOnvDowd—978-2SZ-7663 CSL#099649 HIC#ZS7447 2 OP ID: MH DATE(MM/DD/YYYY) T'I F I F L I I L I T'Y I N U R�4 N 10/26/2015 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). PRODUCER CONTACT Segreve&Hall Insur.Assoc.lncPHONE FAX 305 North Main St. A/C No Ext): A/C No): Andover,MA 01810 E-MAIL Lawrence J.Hall ADDRESS: PRODUCER OLDSC-1 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Old School Group Inc INSURER A:Travelers Ins.Co. 25658 '.. dba Old School Roofing INSURERB:Arbella Protection Ins.Co. 41360 297 Littleton Rd. Unit 1 Chelmsford,MA 01824 INSURER C:Northland Insurance INSURER D: 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 TYPE OF INSURANCE D D L UBR POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C X COMMERCIAL GENERAL LIABILITY WS232756 12/16/2014 12/16/2015 PD RA E A SES ER occurrence $ 100,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 '.. JECT POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE B X HIREDAUTOS 1020000245 06/01/2015 06/01/2016 (PERACCIDENT) $ X NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S '.. EXCESS LIAB CLAIMS-MADE AGGREGATE S DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY X TORY LIMITS ER '.. A ANY PROPRIETOR/PARTNER/EXECUTIVE Y� NIA A E.L.EACH ACCIDENT $ 100,000 OFFICERIM(Mandatory in H)EXCLUDED? TBI 10/21/2015 10/21/2016 E.L.DISEASE-EA EMPLOYE $ 100,00 (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) '.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. Building 20,Ste 2035 AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD OP ID: MH DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE `..,� 10/26/2015 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 endorsement(s). PRODUCER CONTACT NAME: Segreve&Hall Insur.ASSOC.Inc PHONE FAX 305 North Main St. A/c No Ext): AIC No Andover,MA 01810 E-MAIL Lawrence J.Hall ADDRESS: PRODUCER OLDSC-1 CUSTOMER ID#: INSURERS)AFFORDING COVERAGE NAIC# INSURED Old School Group Inc INSURER A:Travelers Ins.Co. 25658 dba Old School Roofing INSURER B:Arbella Protection Ins.Co. 41360 297 Littleton Rd.Unit 1 Chelmsford,MA 01824 INSURER c:Northland Insurance INSURER D: 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. INSRA,DDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED C TCOMMERCIAL GENERAL LIABILITY WS232756 12/16/2014 12/16/2015 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE B X HIREDAUTOS 1020000245 06/01/2015 06/01/2016 (PER ACCIDENT) $ X NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS ERR A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 OFFICE(Mandatory in ER EXCLUDED? N/A TBI 10/21/2015 10/21/2016 E.L.DISEASE-EA EMPLOYE $ 100,000 (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TowTown of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TowACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Building 20,Ste 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents 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 Legibly Name(Business/Organization/bdividual): 06 b sc 14JUL 6/10W d Address: 41 rl Xel UA 1 44 3 City/State/Zip: (Ugllbxl-dr"+ flih 6/ ' Phone#: z S"( " Are you an employer?Check the appropriate box: Type of project(required): 1.d l am a employer with ^�th' employees(full and/or part-time).* 7. ❑New construction IF]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. F1 Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurancerequired.]t 10[]Building addition 4. 1 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 I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance., 6.0 We are a corporation and its officers have exercised their right of'exemption per MGL G. 14.Q Other 152,§1(4),and Ave 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. 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,they must provide their workers'comp.policy number. I anti ati eniployei-that is providing tporkers'compensation iiisaarance for'nay employees. Belolp is the policy and job site information. Insurance Company Name: f Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 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 WORD 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 verific on. I do hereby ce ti under fire pains andpenalties of perjury that the information provided above is trate and correct. Si nature: Date: 0— °T Phone#: °° 7 & Official rise only. Do not sprite 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter then self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia I Massachusetts - Dei:aft;ri eiint of Pubfic,Safety ar Board of BWWing RegWations and Standards t:"O n%tr a on "t':rpwa�°ll i�sor 5up4ah:G: i Ucbnse-1 CSSL-099649 ANTHONY N DOV�D 9 DIGITAL DR#21121 Nashua NH 03062 02/28/2016 _--------- Office _ .. .Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistratian: 157447 Type; Office of Consumer Affairs and Business Regulation Expiration; 101212017 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 OLD SCHOOL GROUP,INC. ANTHONY DOWD 297 LITTLETON RD CHELMSFORD,MA 01824 Undersecretary Not valid without signature