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Home My WebLink AboutBuilding Permit # 11/16/2015 jo�yo oa bab BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Pennit iia# /y Date Received f f �SSACHU5e4 Date Issued: dtTANT:Applicant must complete all items on this pa e \\t OOYea \PARCEL` \ZONN IVG DISTRICT \\\Hi o` istn p g \yes\\ vAv� v y y y y\\Vv v�v \..;yy..... ... .yA Machin@ Sho,Villa eyes o TYPE OF IMPROVEMENT PROPOSED USE esidential Non-Residential -i New Building R,KOne family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No.of units: ❑Commercial XRepalr,replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑Other ❑Septic ❑Well � ��loodplam `Q Wetlands v�V 7\A��Uat�sli�\tl�lsttict � _ DESG321PTION OF WORK TSO BE PERFORMED: Identification-Please Type or Print Clearly n?�E OWNER: Name: 1C-1 Phone: Address: v v vv v v Contractor Name Phone vvv v ..Email Address SuSINConstruction License \ \\ \\Exp\Dat\ \`\ pe rVisor �� VAAV"\A`�A V vAVVA vvA V A\mow A\� �V�Av�\\VA Home,lmproyernent Licensees ARCH I T ECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT.'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED O 125.00 PER S.F. Total Project Cost: G FEE:$ Check No.: Receipt No.: NOTE: Persons contracting ivith�unregistered contractors do not have access o the gu ranty,fund Signature of Agent/Ow Signature of contractor -town of � gyOR'Ybg ..: _ Andover No. ® a h ver,Mass, 9,q q�RAie o WPpP,�q� S L) BOARD OF HEALTH Lim PER IT T ILD food/Kitchen Septic System THIS CERTIFIES THAT........ t. BUILDING INSPECTOR Foundation has permission to erect..........................buildings on..�.. . ........ ...... .. ...................... Rough to be occupied as..... .. V..ehis ...... ...... ............................................................ Chimney provided that the person apermit shall in every re ect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 T ELECTRICAL INSPECTOR ® UNLESS CONSTRUCT S TS Rough Service '' ..... .................................................. Final BUILDING INSPECTOR GASINSPECTOR ®ccupanct Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises—Do Not Remove Final No Lathing or Dry Wall To Done FIRE DEPARTMENT Until Inspected and Approved by the Be®Building Inspector. Burner Street No- Smoke Det. A Page No. / of /" Pages Supervisor CS 068461 Fully Licensed&Insured Home Construction Reg.#146722 9 H�eETTS, G y P Y f/. • fy B391Roo MR m qT� p J North Readin& IM LFII 978276-3043 COLLECI10 CetainTeed[i' SII PROPOSAL SnSb'ITTEn TO PHONE CATE �„./ v' STREET - f JORNq CIN,STATE AhY]ZIP C00'c JOS LOCATION We hereby submit specifications and estimates for: - / Recommended Optional (Included in price) (Not included.in price) Rip&Remove all shingle debris from roof&job site: /1 la yler 2 layers ❑3 layers or more •Z Repair/or Replace any roof decking;not to exceed 50sq.It. v Install 8 aluminum drip-edge/and rake-edge along entire perimeter.Choice of mill white r brown •q/Install ICE&WATER underlayment along horizontal eaves,valleys,sidewalls and sky-fghts&chimneys Install premium base sheet underlayment between roof deck and roofing shingles Y 151b.felt O 30#.felt • Install 25yr CertainTeed/GAF/IKO traditional 3-ab roof shingles .130 year •}f Install CertajnTeedAF IKO architectural Killetime roof shingles p +rte S 0 'See manufacturer warranty policy for more details Install new aluminum vent-pipe flange(s) •q,✓Chimney(s)-counter-flash and re-step existing flashing -1 Cut&Install new lead flashing Ridge v exhaust vent with low profile design,hidden by shingle caps Soffit-ventilation ®Roof louver-vents "' ,`✓� ,� • Seamless style aluminum gutters-custom fabricated at job site 3 downspouts Other - ,c✓ O'Keefe roofers will properly dispose of all roof debris in our own dump truck. "Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-oH Price includes all items above that are checked only/others may be priced separately upon request. Pe Iffrapase hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: 11 Total price not including options.dollars($ � Payment to be made as follows: 3D%deposit required upon delivery of materials.Balance due in full upon day of completion. Please make all payments out to Michael O'Keefe,21 Francis St.,No.Reading,MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized ;;/ li' �� completion. Signature c-�!>:r� -Accepting proposal means agreeing to the terms of the enclosed binder Note:This propos nay be contractwithdrawn by us if not accepted within days NOTICE Y NOTICE TOTO - lw EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street,Suite 100,Boston,Massachusetts 02114-2017 617-727-4900 As required by Massachusetts General Law,Chapter 152,Sections 21,22,&30,this will give you notice that I(we)have provided payment to our injured employees under the above mentioned chapter by insuring with: A.I.M.Mutual Insurance Company NAME OF INSURANCE COMPANY P.O.Box 4070 Burlington,MA 01803-0970 ADDRESS OF INSURANCE COMPANY VWC-100-6017884-2015A 10/12/2015-10/12/2016 POLICY NUMBER EFFECTIVE DATES 200 Park Street Byefte Ins Agency Inc dba A&K North Reading,MA 01864 NAME OF INSURANCE AGENT ADDRESS PHONE Okeefe Roofing LLC 21 Francis Street North Reading,MA 01864 EMPLOYER ADDRESS 10/14/2015 DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act.A copy of the First Report of Injury must be given to the injured employee.The employee may select his or her own physician.The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury.In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuurt to this statute,an employee is defined as"...every person in the service of another under any contract of Hire, expres's 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 ajoint 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 anotherwho 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 ifs 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=contractor(s)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-in'smed companies should'enter their 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 pennit/license munber which will be used as a reference number.In addition,an applicant that must submit multiple permit/Rcense applications in any given you,need only submit one affidavit indicating current policy information(ifnecessary)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 proofthat a valid affidavit is on file for tribute 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-4 617-727-4900 ext.7406 or 1-877-MASSAFE Fax 9 617-727-7749 ILevised 02-23-15 wwwnaass.gov/dia Boa o of Ba Idin C n"Iru''f11 n S 1'1'\non CS-068461 MICHAEL OIUEFE 21 Francis Street- _ North Reading MA 01864 Comn�ssone; 02/24/2016 - Office lfCllsnnlllAfffih,&8usincss Re6ulntiun Il tf3OMEIMPROVEMENT CONTRACTOR Expiration: 146722 Type: �.� ;Expiration: 5/1172017 DBA O'KEEFE CONSTRUCTION MICWIL O'KEEFE 21 FRANICIS STREET _ NORTH READING,MA 01864 Untlersccretnry