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Home My WebLink AboutBuilding Permit # 12/7/2015 ....................................... A-1 4404 01 %AORTHgq BUILDING PERMIT E C. TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ATeD Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 2- 1-�ARA Print PROPERTY OWNER Print 100 Year Structure yes no MAP A PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building iAl One family El Addition 11 Two or more family El Industrial El Alteration No. of units: El Commercial 0 Repair, replacement El Assessory Bldg El Others: El Demolition [I Other DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly /1) p Phone: OWNER: Name: <--- /5 Address: a 0 1L,�,1;76d,;A tk44) Contractor Name: 41ex Phone* w...J/ Email: VA)- ( Address: f< 4 Supervisor's Construction License: Exp. Date: 2- Home improvement License: Exp. Date:- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDINGPERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST,BASED ON$125.00 PER S.F. Total Project Cost: $ 0, 6 FEE: $ Check No.: �A, I � Receipt No.: 2-ci NOTE: Persons contracting W, Z unregistered contractors do not have access to the uararz fund T. 7 NORT-H dover Town of '�-i An ® C% h 1 ver aSSq O LAKE 7 COCMICMl WICK V� RATED P4�,`'�5 l] BOARD OF HEALTH Food/Kitchen E _R I i T LD Septic System THIS CERTIFIES THAT . ............................... BUILDING INSPECTOR Mew . ... ..... . Foundation has permission to erect .......................... buildings on .. ... ..... �..... %VL.......... ............................................................... Rough, 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 MONTHS PERMITI I MONTHS ELECTRICAL INSPECTOR LESS R CT 0 ST S Rough Service ................ ........ ... .. ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Puildin 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 Approved y the Building Inspector. Burner Street No. Smoke Det. / / a tl�s�+�rutu ra F'esiden-Nal Con. t eirc6ai P*100-fins. CHO'9 010 UN EVS PO,(IM-0 ED-REEUH�7-CAPPED All Types Of -xpert Masonry Work (Vass Toll Free Licensed& Insured 1-800-WAIT-4-US u� Locally o's dd sj 076 a License#034200 (924-8487) z1awz cz S?Ch'." We , Worilc 'ilcar IRounct Proposal To: Pete & Kathleen Bennet Date 1.1/19/201.5 Street: 127 Kara Dr. 978-273-78S9 N. Andover Roof proposal kathleenbentlettl?7@gmail.coni. Certainteed Landmark 1. Extra caution will be taken to protect House and 12. Removal of all work related debris.Planks will be landscaping as best as possible. (tarps etc.) placed under dumpster to prevent any damage to Magnets run at final clean up. driveway. 2. Remove all shingles from entire house. B. Building permit included. a� 3. Inspect and re-nail any loose or lifted plywood. 14.Contractor workmanship warranty: 10 years under Any compromised plywood will be replaced at an normal wind and rain conditions. additional cost of$70.00 per sheet of 1/2"CD:K. �\ 4. Install heavy gauge 8" aluminum drip edge to all Total roofcost: �99�Q�e�� eaves and rakes. White, brown or mill finish 5. Install 6' of Certainteed Winter Guard ice and water shield along all eaves and top to bottom in Certainteed 3Star extended direet WifG warranty all valleys. A fully transferable 100% coverage against 6. Install Certainteed Diamond Deck synthetic material defects for a fully non pro rated period of underlaynlent to remaining sheathing tip to ridge. 20 years. Please refer to pamphlet left in estimate 7. Install all new pipe boots. folder. Offered to our local referrals and included �l 8. Install Certainteed Swift Start starter shingles to in this proposal at no additional cost. all eaves. ( 9. Install Certainteed Landmark PIZO Limited Balance due upon completion lifetime architectural shingles to entire house. l0 year material MPG. warranty. (See extended References available upon request warranty) All shingles will be installed and fas- tened according to nifg. specs. Highly rated member of the accredited BBB and 10. Install new GA.F Cobra ridge vent and cap with Angie's Last color matched Certainteed Shadow hip and ridge shingles. (MA code) 'hank you! I I. Counter flash existing chimney lead and all roof protrusions with ice and water shield,tie into nc\v shingles and seal with clear Geo-Cel sealant. Acceptance of Proposal--1'11e above prices, specifi ations and conditions are satisfactory and are 14erby accepted. You are authorized to do the work as speci fed. Payment will be trade as outl.itled above. Date of Acceptance: Signature:-24— t2 r V The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mas&gov/die Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business Organization/Individual): (/ Y ✓f 11`"L 4- Address: City/State/Zip: J Phone#: Are you an employer?Check the approprlaw boa: Type of project(required): I.®I am a employer with employees(full and/or part-time).' 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.)t 1 ❑Demolition 10❑Building.addition 4.❑l 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 sok 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.QRoof repairs 'Mese sub-contractors have employees and have workers'comp.insurance., 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.00ther 8 l-14, 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that chocks box#1 must also fill out the section below slowing 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. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employers. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informadon Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: I ReA J A ! 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 S 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 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 of perjury that the information provided above is true and correct Signature: Dat 1 f Phone#: O,B9cial use only. Do not write 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.CityfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE FDhtE(tdAURDNYYYI 5/2612015 HIS CERTIFICATE IS IS51JEU AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FQ!?.DER, THIS ERT'IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES C-LOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURFR(�), AUTHORIZED :aPRESENTATIVE OR PRODUCER AND THE CERTIFICATtr HOLDER. MPORTANT) If the certificate holder Is an ADDITIONAL.INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the canmvs and condfJons of the polity, certain policies may require an endorsement. A statement on this certificate does not confer rights to the efti(icate holder In lieu of such endo'sement(s). _ Cit>uri-- CONTACT Berkle NA!, Assigned Risk Services lYttvemai Insurance Agency Inc F WNE $QD 534-45$9 tic.„a: 866 215-81 i8 7 # Irrtont St ,Eon ss: PO(IcgSatVicesCberkiayrlsts.eom ftPC@Ster, MA 016.04 INSURER AFFORONa COVERAGE NAICVt Ir Ue A- Ac-adla Insurance Co. 11a25 ^•�n=0 LLatJ.tEk e: MIG Construction Inc i, uHHCR c: -S Congress St INSURER a 6Gord,NIA 01757 1'—'UR ER e. INSUIER F; CERTIFICATE r.UrIBER: _ REVISIDH NU.ABER: _ TtSEISilS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE'BEEN ISSUED TO THE f�SURED tWIAED ABOVE FOR THE POLICY PERIOD NOIC4TED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS �r-RTIFICATF MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A(1 THE TERMS, E XCLLRS(OtdS A.ND CONDI M4$OF St1CH POUCfF-$.4VAIT6 SHOWN MAY HAVE BEEN REDUCED BY PAID C LAIMS. s; g u :F PaLJ v rx TR TYPE OF INSURANCE IN5R {CND POL,CYNULtB:ft ,.tL1(DDIYYY wAIDD,YYYY) LIMITS D ENERAL LIABILITY AUTO=811S LIABILITY b VIORKSRS COMPENSATION WC STAT U. OTH AVD ERIPLOYE„5'LIABILITY Y/NTORY LIWTS BR ANY PROPRIETOR,PARTNEk/aCCUMC �S EL EACH ACCIDENT S 1,000,000 w. OFFICEIME1MSEREXCLUDECT NIA ❑ WC-20-20.00565MD 05/2012015I 0bf2Df2016 (Mnhtiatory In NH) E.L DiSEASE-EA WP OYES S 1,000,000 II yes.dso6ba under E. 11000,000 DSGCRIPTDNOF,9PERAT,ONSuoJry _ L. nIs ASE-PouCYLIMIT -r4R,PY to OF OPEFIATIONS ILCCATt-Ng(VEHICLES(ACMzb AyORD t01.Fdditlartat Rarrkc Schdet Jb.IT rre SAC.-*Is cequitdp '.. Coverage. ?=31isn Category Elect.$WW5 Name State(s) NI F tit+ss lncaliorts Wr cer Include Maria Gumman MA VIGG Construction Inc 93 congress St N111ford,NIA 01757 ORE1FIGATE HOLDER CM4CELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I N ACCORDAME WLTH.T.HE POLICY. PROVISIONS. Nil Under One Roofing UTHOR17-W REFIRSS04TIVE M Temple at , ethuen, MA 01844 Signature; -- :ORD 25(2010/05) BRAC,3130 t as Mies ah sc�i�s.Depavtment of Public 5a4tty Board of Building Regulations and Standards cono€uefinli egg _ -License: CS-069120 109 7 30TEM DR 3VfETHMMA 2184 �w will t� �x it ttt�tt Cs�enret3sstcn�v 00&2017 17F'iY1fLFl RL'T�,tbitcs7lG,yt • Click on bie registration number to view COmptdint history,You can 8160 view arpi n and Cuarant EVnd hist. The list ilwcurrent as of Wednesday, October 8, 2014, Search Results RE t' Zjr1NT RESPONSIBLE REGfS3'tr2A`1'to" EXPIRATION INDIVIDUAL WhIDER STATU ALL ummR 01m ROOF• LANZAt✓AME, 1-37057 1B6-,R itllEfif2tltliACK 5T 1010212016 Current JOHN METHEUN, MA 01844 02092 Commonweattin of Massachusetts, Mass•Govlg�is a registered service mark or the conirtion"aith or(Massachusetts, i. -