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HomeMy WebLinkAboutBuilding Permit # 11/23/2015 tkORTH 1 E D BUILDING PERMIT ,F.D q TOWN OF NORTH ANDOVER 0 a APPLICATION FOR PLAN EXAMINATION Perm.-No#: Date Received Date Issued: javirijkrANT: Applicant must complete all items on this page LOCATION Pri PROPER NER Print 100 Year Structure yesno v MAP PARCEL: ZONING DISTRICT: Historic District yes no �o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Rei ial Non- Residential El New Building ne family 11 Addition [I Two or more family El Industrial El Alteration No. of units: 11 Commercial El Repair, replacement El Assessory Bldg [I Others: El Demolition El Other if 1,r __ I Vfl 01901,64 ftf," j� ❑" V lldmoqf�� �e lan Pj T w, ,as 10,1 f DESCRIPTION OF WORK TO BE PERFORMED: 1XI denti iGa iow,- Please Type or Print Clearly 2 OWNER: Name Phone&-, Address: 2 Contractor Nanao� k' VAV. Phone- 0/7k� Email: Q 0- Address: :5704�_ '00�4�1 1�gr Supervisor's Construction License e Date: Home Improvement Licens I'l 1�2Exp. Date:_ ARCH ITECT/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. I el Total Project Cost: $ /o D FEE: J—ll) Check No.: l Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tot uaranty fund 6m q t —of-pon fa ... ..... rim F tAORTH 1,1wn o liduvel ? e ® b LAKE h ver, Mass, CoCMICMEW.C.t �1' 2"ic ATEo P4 �(5 U BOARD OF HEALTH Food/Kitchen ERMIT Septic System THIS CERTIFIES THAT ,, ,,,,,,, ,,,,, ,, , ,,,, ,, , BUILDING INSPECTOR .............. .. ... .... ........ has permission to erect . .. building n . Foundation . .. . .. .. . ... . . Rough Ill . to be occupied as ..... .. ..... .. .. . ....... .. .... .. ..... ..... 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 PERMITI I NT ELECTRICAL INSPECTOR T T Rough Service ............... .... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired t® Occupy,fuddin Rough Display in a Conspicuous Place on the Premises — ®o Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Proposal ® ' HIG#174377 D Damphousse Roofing LLP A trusted name since 1938 "'4 Roofing ® Siding - Windows 87 Belmont Street - North Andover, MA 01845 P: 978-683-4588 ® : 978-685-7446 NAME OF OWNER � ADRESS OF JOB TEL .e� � r "� ilP TE: " 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 ' rchitecturaI, roof shingle installed with a limited lifetime warranty. Install new ventpipe boot flashings. Waterproo existing chimney flashing and remove debris. Shin le Calor: 6 ",F .m ..._ Ridge Vent Upgrade Wood Sheathing Repair$3.50 per ft µ � `r leeE We Propose herby to furnish material and labor-complete in accordance with above specifications,for the sum of: dollars d y lower Pa men�,t�o be ede as fol Authorized - Signature ., n " ,Af— NOTE:This proposal may be withdrawn by/us if not accepted V(t,k 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. Signatu Date of Acceptance: °� Signature HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS(MGL 142A) 1. WORK:Provided the Homeowner performs under this agreement,the Contractor shall perforin 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 Contractor's 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 cormnencement 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 2 years after substantial completion of the Work the roof will be fi-ee 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 Homeowners.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 tinder 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 perforin the work as covered by this contract;(b)the Homeowner has funds available to make full payment ander 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 roofing nails penetrating through roof decking and will be visible on the underside of some surfaces. The Homeowner indemnifies,exonerates and holds harmless the Contactor 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 agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not later than midnight of the third business day folio g the si ning of this agreement. HOMEOWNER: DATE: .� g , � Shin le: DEPOSIT:` The Commonwealth ofnlassachusetts Depaj7nieitl of Iiidtrstrial Accideizts Office of Investigations 600 6fashingloit Street .Boston, MA 02111 i wimnass.gov/dia Workers' Compensatiol? Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual)' C Address: City/State/Zip Phone#: Are y an employer? Check ihe� ppropriate box: Type of project(required): 1. I 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 attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, workers' comp, insurance. 9. Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their •10.0,Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12 Roof repairs insurance required.] t employees. [No workers' 13.E] Other comp. insurance required.] *Any applicant that checks box#I must also 611 out the section below shouting their workers'compensation policy information.' t Homeowners who submit this atTdavit indicating they are doing nil work and then hire outside contractors must submit a new affidavit indicating such IContraclors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy it Eorrnation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ittforinatiorc. Insurance Company Name: e�Z,,<— Policy#or Self-ins.Lic. #:� `� �( ( � Kxiration Date: " Job Site Address: �- `S/®a �� Cily/Stale/Zip Attach a copy of the workers' corilpensatio pglicy declaration page(showing the policy number and expiration date)'. Failure to secure coverage-as required under Section 25A ofMGL c. 152 can lead to the imposition of crbninal penalties of a Cine up to$1,500.00 and/or one-year iinprisorunent, 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 stalement.may be forwarded to the Office of Investigations of the DIA for inswrance coverage verification 1 do hereby cWify tutr hepai rdpenalties ofperjui),that the information provided above is true and correct Signa tore: ��m Dale: .Phone#: -OjTtcial use only. Do not write in this area, to be completed by cif)or torp', offrciaL' City or Town: Perrnit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. CityiTbwn Clerk 4.Electrical Inspector 5..Pluutbing Inspector 6..0th er Contact Person: Phone#: 4/ 17 /2015 11 : 05 : 02 AM 8790 ® 02/02 CERTIFICATE F LIABILITY INSURANCE0 DA4117/DDIYYYY) 0 411 7/2015 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). ACT PRODUCER 00474-001 NAME: PHONE 978)475-0260 Doherty Insurance Agency Inc (A1C.No.Ext): ( 11N.No.: PO Box 1985 EMAIL AooREss: Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC# INSURER : A.LM.Mutual Insurance Company 33758 INSURED INSURER B Damphousse Roofing LLP INSURER C 87 Belmont Street INSURERD: North Andover, MA 01845 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSR VWD POLICY NUMBER MMIDD/YYYW PMILDI DIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence) CLAWS-MADE F—]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ —POLICY ECT OC AUTOMOBILE LIABILITY aD SINGLE LIMB cCOMBINED $ ANY AUTO BODILY INJURY(Per person) $ ALL ONMEO SCHEDULED BODLY INJURY(Per accident) $ AUTOS AUTOS NON-OVMED PROPERTYDAMA.GE $ HIREOAUTOS AUTOS (Per occident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ g UU $ yyORKERS COMPENSATION X TORY LIJTifTS Eft AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 500,000.00 oFF, Ril'IEMBERaXCLU D? �EXECUTIVE NIA AWCd00-7028774-2015A 4/17/2015 4(1712016 A E.L.DISEASE-EAEMPLOYEE $ 500,000.00 (Mandatory In NH) DESSCRes -b O�dOPERATI0N5 belowE.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if 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 �`/� �� � ,�'`� J :--� ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 6913 Client#: 14415 DAMPHOUSSE ACORD- CERTIFICATE OF LIABILITY INSURANCE 04/17/2015 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.Bax 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 NAIC# 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 5 TYPE OF INSURANCE POLICY NUMBER 0 TE IMFMFMDCTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY NPP8202847 04/12/15 04/12/16 EACH OCCURRENCE S1 000 GOO X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED omurrAncel $100,000 CLAIMS MADE a OCCUR MED EXP(Any one Poison) $5,000 PERSONAL&ADV INJURY 51,000,000 GENERAL AGGREGATE s2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 X POLICY PRO- JECT F1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Eaaccident) S ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per aWdonl) S PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE $ RETENTION S S WORKERS COMPENSATION AND WC STATU OTH• C EMPLOYERS'UABILfrY ANY PROPRIETORMARTNERIEXECUTIVE E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yos.describe under SPECIAL PROVISIONS below E.L-DISEASE-POLICY LIMIT I$ 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 J0_ 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 REPRESENTAT)Y AUTHORIZED FkPRESENT TIYE ACORD 25(2001/08)1 of 2 #S31838/M31835 DML O/AIWRD CORPORATION 1988 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-067560 Construction Supervr sor SHAUN M TWOMEY 61 PATROIT ST NORTH ANDOVER MA 01845 (--j, nn Ck-- Expiration: Commissioner 10/25/2017 Affairs&B sm� „�._.w....,, ". Office a ons° er Affairs ess Regulation #=,_ HOME IMPROVEMENT CONTRACTOR Type: Registration: 174377 LLP _ Expiration: 2/4/2017 .,.� DAHOUSSE ROOFING LLP i SHAUN TWOMEY 87 BELMONT ST N.ANDOVER,MA 01845 Undersecretary I