HomeMy WebLinkAboutBuilding Permit # 12/1/2015 . ... " ,40eTry
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BUILDING PERMIT 0
TOWN OF NORTH ANDOVER ° t 0
APPLICATION FOR PLAN EXAMINATION * -
Permit NO: Date Received
"ATED
Date Issued: 8
IMPORTANT: Applicant must complete all items on this page
LOCATION � �
Print
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PROPERTY OWNER � � i" Pr
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District ;yes
Uo
Machine Shop Village
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
11 Addition El Two or more family 11 Industrial
❑Alteration No. of units: C:1 Commercial
C&Repair, replacement I I Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District
❑ Water/Sewer
r'e ...1,-oo
Identification Please Type or Print Clearly)
OWNER: Name: � � "°� � " Phone:
Address:
CONTRACTOR Name: " Phone: °102-
Address.
a, �.. �
Supervisor's Construction License: Exp. Date:
J , ° .
Home Improvement License: Exp. Dater'
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: $ 1 m �' FEE: $
Check No.: 6 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor ''.: ;- �2
F t%®RTH
Town ofL
Andover
0
® ilk
Z h ver, ass C�
O LAKE
COCNICftl WICK
ADRATE D PPS\
qS U BOARD OF HEALTH
Food/Kitchen
PERMMTSeptic System
BUILDING INSPECTOR
.... •••.•
THIS CERTIFIES THAT . ••••••• •••••••11,
. ..r........... ..
••• Foundation
... buildings on ................
has permission to erect .......... .. ....... Rough
Chimney
........... ...... .. .. ................................................................
to be occupied as ............ ...ths
..........
Final
provided that the person acceptIng permit shall in every respect conform to the terms of th�ltepat on'and
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, PLUMBING INSPECTOR
Construction of Buildings in the Town of North Andover.
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
ELECTRICAL INSPECTOR
PERMITI
LES TI TF5 Rough
Service
Final
BUILDING INSPECTOR
GAS INSPECTOR
ccupancy Permit Required to Occupy Buildznz Rough
Final
Displayin a Conspicuous lace on the Premises — Do Not Remove FIRE DEPARTMENT
No Lathing or Dry Wall To Be Done
Until Inspected an rove the Building Inspector. StreetrNo.
Smoke Det.
:..Jrtitcar��c:r,..11c�r��c.rn�t��.r \rarr7�� C'r�ma4ra7�?��rriiG �
Joel Merson Precision RmAn€ . L1.C"
NLA l l lk' .. 130275. c°x p. ? 9 2-010
street <�ciclrc>s Jobsite C'crntractcar L3irsincss ()��rrerName
180 Lancaster Rd Erik Ilaamnaar
—_ Wk U`L 0 99WA (RF. " '; A eM 1U 1 1 015
Startc— _ iwX� t3�r flies" ,Address
North ,�ndov crr M'I'A 01 450 750 Ne"UA;n Rd Suite Ili~- 1.ittictmm M A O1-60
1)aa�tiaaae I'lai�rac 9ailA .`tid4 ess
Lrcninn P1tcrne 550 Ne"=n Rd Suitt; 115- I..ittletcm. 11,-1 0146f)
joal a esafety inc.com F'3>tsr_rfcss I'hon„e
078135J 023
Fedi��AI_r)zLlov cr 11')
20-2820250
WORK TO BE 1'E;1U()WNIlm:D , ND 70.rt4.'f'L".Ct.tAl.,S F0 IF, US KD
(bnlrwuw agrees to do the %', wk. nand to WK the materials. described ht:IO" Or Ilomco"ner: �
.lcq&c gall necenny pumAt.s.
Install tarps prior to shingle remm al to pnAect the house. landscaping. decks and A U unite.
e Strip cal"f all old shingles Irom roof. danaail substrate and repair rmplace imed boards.
@ Nait off arae loose substrate sheathinLl.
a Install Premium M18. 8-inch mill finish aluminum drip eif ing along all rool'side (rake) edges. �
e Install new mill finish azlunaintrm vem pipe flanges.
* Leave in phwc and rause existhg aalunaiatum stela mashing where rcrc Hinesjoin vertical Ws. �
a hastall rn';'w arhnlnwn Hashing around chinme) under behind existin<,., lead Hashing.
* Inspect existing lead chinancvflashing An adequacy "Ah ('oranrctrrr"s 1fl year M azar).
a hastaall CertainTeed rid"ge vcnt at all ridgelines. per maanullaacctur°r specifications.
e Apply as 60of width if(IrhdnTeetl Wnter Guard" tmdedaaynient as WmNs: Wig rncrt"hotton)
v:dt es: up v allow,,: aarcrintd sky lig"ht;, chimney and van pipes. Applic:aation "Al extend Lander exis'tin,x
strap flashing.
s WmAl C:emOnTeed 17iaimund Deck synthetic underlgiucaat over remaining exposed sheathing,
Installation \trill extend under existing, stip 11 ashing.
e Install (:ertWnUed Lanchuark LinPled Life=time mchitcctund re.7c rdAngles of select calor.
f'OlI0vv in",! In arritl"aactura-'S applieaatia::rn specifieations.
In;K C'eM ain Teed `writ"t Start I.acto r} enhanced starter strips along evw and rakes anel fa aory
<:"nlranced Shadow Ri �:^
d� , riti, cap, Increasing "iaad "aarramtee to I 3(.)r77pla.
* Fasten rm)Fshin4!les Wdi sirs nails per shingle Kollo"ing trrarnufacturer's nailing pattern. 'Fails are
gaak anized steel 1 C by l 1";"' smmah sNmk "Ah 3'8- diameter head. No maples W he used.
a Clean and s"cep jobsite daily �Oh a rnaagnet.
e Remove old shingles ancf relmed debris fr'on't"job site.
* Ocanjobsite groumk upon completion of'aall work dc;sc.rihed.
a Leave two rooting bundles An home ower "ten job is complete.
OTHER CONDITIONS, NVARRANTIEYGUARANTIES, WORK SCHEDULE
• \\ork area to be completed is the entire roof. Exposed areas will be protected from inclement
weather.
• Total Contract Price includes replacement of two 4-foot x 8-foot sheet of plywood if needed.
,additional pIN wood replacement will be S50.00 per 4-foot x 846ot sheet. installed. Thickness of
replacement pl}Awood Will match existing substrate sheets.
• Total Contract Price includes disposal fee for old shingles and related debris.
® CertainTeed's Limited Lifetime 'vVarranty on shingle materials is per Homeowner-s registration
available online at wxNAv.Certaintecd.com.
Total Contract Price includes Contractor's I -sear Wzin-ants on labor covering anv leaks associated
ssith poor ssorkmanship: chimne}-roof flashing joints, loose sheathing" raised nails, loss nails.
sunken trails. bent nails. improperl} installed ice and water, paper, or shingles (%yarrant} does not corer
extreme acts of nature).
Precision Rooting. LLC is not responsible for existing hidden damage. excessive rottim etc.. and if
discovered vsill cause all work to cease until there is an agreeable solution betsseen both parties.
Permit cost vary greatly from town to town, permit cost«•ill be additional to the final bill
based on your towns rate.
The Jrtllotrim schedule ivill he 4141hered to nttless circ'ttit S1(M(e.s bevond contrac°lor'.s control arise:
';tti ,d,; -;ch�:duk-'d l t1 t )1.1, "Ch ,"'h2d lig I ndi I 1 10
PRICE AND PAYMENT SCHEDULE
Contractor agrees to perform and warrantee the ssork, plus furnish the materials and labor, as specified
above. for the SUM of.
Good' Landmark: S 18.4001)0
Homeowner agrees to make pa\ments according to the following SCHEDULE (Cash. Check. Pisa.
MasterCard. American Exprt�ss and Discover are accepted):
1'i upon signing the contract.
upon completion satisfactory to all parties of all work described herein.
All home improvement contractors and subcontractors shall be registered in AMassachusetts. Inquiries about registration
should be directed to: Office ofCorIsumer Affairs and Business Re,,nlation
Suite i 170,Tcn Park Plaza, Boston. MA 02I 16: 617.973.8700 �
Homeowners ssho secure their own construction-related permits or deal with unregistered contractors shall be eXcluded
ti-om access to the Guarantee Fund.
lkll,con ;"vsill be kept bN the Company and should also be kept b� the Homeowner.
DO s(tlV sldsN I III°, COs FRAC F IF I IIERF_ ARF A\N I3I_AK NPA( F.`s
7
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IXSignatur , D'Itc Cuntiact"r,�i"nature t)otr
r ntav cancel this agreement if it has been signed bs a part} thereto at it place other than an address of
the seller,which mar be his main office or branch thereof. provided I lomeosvner notifies the seller in s\ritin,at
Ili,,main office or branch by ordinary mail posted.by telegram sent or by delivery.no later than midnight of the
third business day follosvin"the si�ininL,of the aereement.
Precision Rooting. LLC www,precisionroo1in0-11C.Coll)
The Commonwealth of Massachusetts
Department of Industrial Accidents
" 1 Congress Street, Suite 100
' Boston,MA.02114-12017
•�w< www mass.gov1da
sye W—orkers'Compensation insurance Affidavit:Builders/Contractors/E'E lectxicians/Plumbers.
TO BE FILED WITH THE PEI2MiTTTNG AUTHORITY,
Applicant Information Please Print Legibly
Name(Business/Orgatvzation/tndividual): S��
Address: SSS
City/State/Zip: x � C i IL410 Phone
Are you an employer?Check the ppiopriatebox: Type of project(Tg4uired):
1.a' I am a employer with employees(frill and/or part time) 7. Q New construction
2. I ama sole proprietor or partnership and have no employees working for me in $, 0 Remodeling
any capacity.[No workers'comp.insurance required.] 9, ❑Demolition
3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1-will
ensure that all contractors either have workers'compensation insurance or are sole 11.,❑Electrical repairs or additions
proprietors with no employees. 12.E]Plumbing repairs or additions
5Q I am a general contractor and I have hired the sub-cofntractors listed on the attached sheet. 13, oof repairs
These sub-contractors have employees and have workerscomp.insurance.t 14 Other
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we 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.
i Homeowners who submit`this a ffidavit indicating they are doing all work and then hire outside contractors must sgbruit anew 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 Tiave employees,they must provide their workers'comp.policy number.'
lam an employer that is piwvidiiig workers'compensation insurance for my employees.'Below is the policy and,lob site
information.
Insurance Company Name:
Policy#or Self-ins,Lic.#: (O S(,OC)O i ExpirationDate: I ti
fob Site Address: ( � City/State/Zip:
Attach a copy of the workers' compepsation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL e. 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do Hereby certify under the pains and penalties ofperjury tlacct the information provided alcove is true and correct.
Signature: Date: '
Phone# ' + ( j
Official use only. Do not write in this area,to be completed by city or tolvn official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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ALDER THIS Cta€;TIFIGFaTE C1OEf3 fdOT A ;'TON OnLyAND CONFERS No RIGHTS U
CORDED BY THE POLICIES BELQIP� THIS CEI�71177Tg lI145URAi#CE DOES EDF COA+S PON il#E CE CAT
pH= SUIh�1�3S11R1 R(5},Att�}tO �P.rP1,� EXTEND d(�AIiER THE OVERAGE
fi�'�(-JiAMW OP PRODUCER,AND THE CI��'t!'IC�i�T�E A C'0 SE EM
IMPORTANT: FliheCertificseh�l[faa is an
sut�tto thetethe&rrKc$.hQl s arG e ADDITIONAL INSURED,fflemustbe end
not Conrr�ri0is to the certifrrate holdar in t�Isuch n rsttr>nnt(s}. orsetl. errant ct7i"rAYI9f i�5'AtllEp,
� 9�as endoraemsnl Ca atate�rtt an this to�a�s
1 PRUIHK m ;
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WESTFORD INS AGENCY INC RkmE.-
1 PO G4X 308 PHONE FAX
WES)rORD.MA 01886 roti-rte E,n_ vC rpt. I
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PRECISION
AI—PRECISION ROOFING LLC KsuRER a.
126 NEIN ESTATE RD wsuRER G
LITTLETON,[vIhQ14n4 I;
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CERTIFIGATE tdU(�g
THIS IS TG CLF TIFY THAT THE POLICIES OF INSURANCE LISTED 8E R Ion N !`
ABOVE FpR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING ANY RE HAVE
i31 EN ISSUED TO
CONTRACT OR OTHER DOCUMENT>H11}j RESPECT T THE INSURED1AA1ED
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AFFORDED 8Y THE POLICIES DESCR18E0 CIUIREAIENT. iCftAi OR CONDITION CSF AI}y
O D HIER THIS CERTIFICATE MECT TO AY BE ISSUE13 OR MAY PERTAIN Tr9E
CONDITIONS OF SUCH POUCIES-UMITS SHOWN MAY HAVE BE NI REDUCED SY PAID CLAIMS_
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O=&:FZ'r'�hON Cs=O"-RATKINS CCff'a $100,0
EJ-DISEASE-POUCYuki S500,0011
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( SRGULD ANY OF THE A#3OVE DE!iCMBED POLICits S'
GANCFI I F BEFORE THE EXPIPs3T1061 DATE THEREOF,
POi1CY
ldt ,'yE fflLL BE DELIVERED IN AC�DANcE 1t111TF3 T1
PROVISIONS.
AUTHOR»rZZpr2E yl"-
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AGORD 25(20f01L5} TOC TCpaD and r o- m 1968 2010AGORD CO�A19}�p1TtON.AUOg az regitermarks arks o>=ACORD nights reteived.
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Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSSL-099691
Construction Supervisor Specia: ty i
ERIK B HAMMAR
550 NEWTOWN ROAD'
SUITE 115
LITTLETON MA 01460
r--j- 'KCA--L- Expiration:
Commissioner 10/17/2017
''f✓>r• 'f r:o��t�er,r�rrrr✓///c+�l',..,.A'/r�..�r�r•AM��.�/f;
Office.of Consumer Affairs&Business Regulation License or registration valid for individul use only
��'+ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
jjl` ;; � i;f Registration: 130275 Type: Office of Consumer Affairs and Business Regulation
Expiration: 2/9/2016 Ltd Liability Corporati 10 Park Plaza-Suite 5170
Boston,MA 02116
PRECISION ROOFING LLC
Erik Hammar,
550 NEWTON RD
LITTLETON,MA 01460 Undersecretary Not valid without signature
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