HomeMy WebLinkAboutBuilding Permit # 11/5/2015 BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: r t Date Received
Date Issued: I V t� ��— 9
IMPORTANT Applicant must complete all ttems on flus page
CE NIkJG AIS'iRIOTxr r isp D'�sr s �z o
TYPE OF IMPROVEMENT PROPOSED USE_
Residential Non-Residential _
❑New Building ❑One family
❑Addition ❑Two or more family ❑Industrial
❑Alteration No.of units: _ ❑Commercial
❑Repair,replacement ❑Assessory Bldg ❑Others:
❑Demolition ❑Other
t�0 Sep�t1cr sll Y ,Fhnodaip "ihC�/etlatds toWarsh dbi tClctt�z
�_„
DESCRIPTION OF WORK TO BE PERFORMED
Identification-Please Typo or Print Clearly
OWNER: Name: 1cv� C ���,�,�ctv-z` Phone
Address:
4bnfractor 1arB �� Phone i ; 73z
iN
1�,0, ,?.tUpP_ta�ee t= Icense,x `d'v .� ;' l&E3t�. ".;t
ARCHITECT/ENGINEER Phone:
Address: Reg.No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$11,00 PER S.F.
Total Project Cost:$ FEE:$
1
Check No.: Receipt No.: 'c—�- C Z-
NOTE: Persons cont chug with unregistered contractors do not have access to 7anty fund
�ynature of Agent/Owner _ Slgnaturezof cont`r_act �.W
1,97 IAORTH
-town of Y, Andover
No. 591
PER'NITIE ILD _'�Pti'sy'
THIS CERTIFIES THAT..........0.0�rd C* -BUILDING INSPECTOR
provided that the person every respect for 11 to the terms of the application
�m°mmm ��a,i==�*m mm"m�=o=^��m *m �
Construction mBuildings mthe Town mNorth Andover. PLUMBING INSPECTOR
VIOLATION mthe Zoning or Building Regulations Voids this Permit.
PERMIT EXPIRES|W0MONTHS ELECTRICAL INSPECTOR �
UNLE8GC0N8T
'`~ ''
" -- TS
..................... �
BUILDING INSPECTOR
GAS INSPECTOR
Display inoConspicuous Place onthe Premises—DuNot Remove Nul
NoLathing orDry Wall To8nDone FIRE DEPARTMENT �
Until Inspected and Approved bythe Building Inspector. �
tlandlnaared.MemtlaI,,MAaaffaraualnaesaureau ro � �C Or-
4 Fu yt GAF Cert ME#20212 HIC Regble9a n�
f ouvens Coning Prefeaetl Contactor%212825 NIA CS#104728
OSHA as Hour Constructor safety Inm, EPA Leatl safe Gartered
:8881
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51 S.Broadway#2214•Salem,NH 03079 (803)890-0084 1 10 Stevens Street#141 -Andover,MA 01810-(978)475-0095
Mem mei r� 7 WS'3 Z2�
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Completely protect the home with tarps to catch felling debris.Respect and protect shrubbery and flower beds.
Strip off I layers of roofing material down to the bare roof deck,Inspect the roof deck far structural defects-
Determine the condition of the underlying plywood or boards,and repair and replace as necessary*.
Inspect roof ridge for proper 1'Fi"spacing on either s;de of ridge for maximum exhausT ventilation.Cutin if necesaery.
Install new heavy gauge / 1)n^'f;c (rolnrl/�(r fb..maxir drip edge at roof eaves.
Install ('7 GJ� �r.C(�,-ct>,i�and water shield to meet manufacturer's speeificatiens(i.e.6 feet from.roof ecge,3 feet centered in
valleys, rou
and ell skylights,chimney bases,roof penetrations and at all sidewall transitions).
Install L'7 E�amati a .41>cr", breathable roof deck Protection to remainder of the roof deck.
Install new heavy gauge G 11e,,o t (color) Af-M" drip edge It roof takes.
Install JiI 1 -} starter strip at roof eaves and rakes.
Install—a[cols Y.psc,sD C o—i-w t,Iq Ajarp
x )cylscared color. /3b (color)
Install new flashings to meet manufacturers specifications.(i.e.sidewalls,chimneys,skylights anti roof penetrations).
notal
�u (feet)of CALJrr...Sj�+ry„) (yg� idge vent at roof ridge to slow maximum ventilation.
Hand nail to ensure prop fastening
Z,\
Install /$1.(feet)of Ze,\ Isi - p distinctive hip and ridge cap.Hand nail to ensure proper fastening_
Thoroughly clean up and dispose of all roofing debris on property.Magnetically sweep property for nails.
Noes: .rakjeu, �e t�(cf inn Ca �hE r'�^ry.Pey
Edmunds General Contracting will:
^Obtain all necessary constructipn-related permits to complete this project.
Perform work as efficiently as possible without sacrificing quality
Furnish and install all necessary materials to complete the project.
Provide a thorough cleanup and disposal of all debris generated dung project
Edmunds General Contracting LLC agrees to commence walk on/or about
and it prided work will be comple^tedd In about�days.
Product Upgrade 1' X
Product Upgrade 2: ,,
Contractors employees are fully cove red by workman's compensation and liability It is further agreed that this contract may be assignee by the contractor and also
insuance. that the obligations hereof shall bind and apply to their heirs,succosere er estates
Upon completion Of the above work,all undersigned agree to execute and deliver to of the parties.
the"din er their joint note in a,order,with his(their)above ohllgalione as Edmunds General Contracting LLC guarantees all w,dmanship performed for
requested by connector Upon refusal to do so,contactor may at its option daolare 7 S years.
the antra contract price or so much as then remains unpaid,immediately due and -
Payable.Itis agreed that,If permitted by law,contactor shall be paid by the We will retailer I factory ran, it,ar,,P
ernar(sJ all reasonable hosed,attorney fees,and expenses,In endi lu,to She providlnt—Years dak detect cwarage and years of
Dunt due and unpaid,that shall his murred In enforcing the terms and conditions workmanship dared roHe
He
ve methreugh
oler;
of the colmad and/or any hen in-,,action herewith. ma aaaafirnal coal of
r,�maaos'mseea un-,ao
w drtira mapi ��a°aa�r�al c°sr.
Edmunds Genital Contracting,LLC agree ro t nigh the r arc rial ,it -
labor aompaete Ir,acaortle nca with the abcve speoifcations,foe the sum. - -
of F'YPJo1J r�tEi?SCaiwfD �. dollars IS/�/'�� an del zgr1.111s
me nr1.drnmIanamna
NDN�se�
%06
Pftrayment Payment Te ms cmc n,1a1,1u11,1r 11 us
'seam Mon• - o;
t of (not to ul exceed 1/3 of the total contact) ° ,7 spy /o nor r
due p start of work.The balance o d f 10['ps due when w k Author' d S-g t I / /r
A deposit
is
completed to the eatisfact on of all pert'es. a—r-so L
11
•.A finance charge of 15%per month(16%per year)will be charged cn Note:This prop^�I may be withdrawn by us If not accepted within
i
accounts over 30 days `/\� days.
[CCOfPCOp98aI-Thsaboveprices specidear—,and DO NOT SIGN THIS CONTRACTIFTHERE ARE 8lJ1NKy$PACES,
re satisfactory and are hereby accepted.Yau are earnarized to se
tspecified.Payment wll be rcyetle as ontinodAuihOfizetl 51gn6tureceptance:�`'� ' ^
Authorized Signature:
The Commonwealth oflllassachusefts
Department oflndustrialAecidents
_= I Congress Street,Suite 100
Boston,YM 0027
www.mamass.govIdigov/die
Workers'Compensatimt I ianumce Affidavit:Builders/Co¢tractors/Elechicians/Plumbers.
TO BE FILED WITH THE PERNDTTLNG AUTHORITY.
Applicant I f t' Please Print Leeibiv
Name dhoineas/organa-ien/lndivimmi):
t
Address: P6l22�`'1
City/State/Zip: Phone#: Go!- ',Gt
Areyo .employer?CJa,kthcappiopH,-box: Type ofpi'ojeet(Teq¢ired):
1. aemployarwiffi�_employees(fillaadh,parttime).' 7.E]New construetkin
2.❑Iemaeola pmpde[ororparinemhip avd have no employees working formai. $_❑Remodeling
any capacity.lNoworkem'comp.insurance rcquved.] 9.❑Demolition
3.❑I am ahomeowner doing all work myself.[No workers'comp.ivsmavicerequhed.]t
4❑I.ahomeow wdwll mmm—,duceall wodconm balvring Iwill 10❑Building addition wvoo y property.
we 9ratail conGavtors either?rave workus'compmsatiovivsumnce or aze sole 11.11 Electrical repairs or additions
proprietors withno employees. 12.❑Plumbing repairs or additions -
5.❑Iam ageveral contractor ands have hhedtte sub-conhactom lis[edon the attached sheet.
13.0 .Roo repairs
These snbconhacrorshave ev:ployeesa'have worlcers'comp.msurzrice.t L_�q/ /
6.❑Weareawrpomt(on anditr officem have exueieedthehdght of'exempnonper MOL c. 14. th Y
152,§1(4),avdwe have naemployees.[No worlrers'comp.ivsuravice mgvired.] -.
°Anyapplicant that checks box Ylmust alsofill out the sec d inglow ,kIrtdo,workers'compensation pelicyinforma—,
t Ham whosktiitflys affidavit indid.edheyare vil-g ltwork and tlrenfi outridecontra,-.dust submitanew affifis-vdicaturgsuch.
=Contractorstih,cockdrisboxmustettWldan additionalsbeetshowieg thename ofthesucLivy actors avd state whether orvot those evtities have
employees.Ifthe sub-contractors have employees,ttiey must provide their wmlceis omp.policy manber. - -
Zeman ployerthatisprovidingworkers'compensationinmu ceformyemployeesBelow is thepolicy andjob site
information.
]ns man.Company Name:
Policy#or Self-ins.Liu.#: W C 2')j S'°$7 S2— Expiration Date:
w
Job Site Address. ��"� .Its 4,wvv-, k� S� City/State/zip: k" "c cv- Uk of a(5
Attach a copy of Cha workers'c'ompepsarion obey declaration page(showing the policy¢umber and to).
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 ofthis statement may be forwarded to the Office oflnvestigations ofthe DIA for insurance
ct
coverage verificafio
Ido here,y cer ad,, pains andpenatties ofpeijuiy that the informado¢provided am
/be is true and corre
Signaturek�t Date' //i! V 15
Phone#: � t 3� � 77
Official us and o notwrite in this area,to be completed by rlty m•fawn nffxczat.
City or Town: Permit/License#
Issuing Authority(circle on l:
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electirieal Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
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