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HomeMy WebLinkAboutBuilding Permit # 12/7/2015 %1ORTM BUILDING PERMIT o' 44ED �q TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION o _ Permit No#: . Date Received I �„9 DRwTeo SSACHU`'�C Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION / . A— Z-44,­7 PROPERTY OWNER 141 Print, IVNIf\ t, Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 � �;�1G�,�r r✓, ic, fii.r,�, al/r //i, //l. / a dli��futi�„ ,n�1/ r ✓ � i,�,,/ i.�/i,�� ldl°�Dx'afo.: � �' I(4,,�� Sept ells �j I� ,❑Floodlai �,�Wetland 1 /Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: v, ke Phone: 1 '�06 .M 1'f Address: [ Ga C, t - ContractorName: _ Email: Address: " 0 7 pi< z2 1 0-4 -') Supervisor's Construction License: L)8 Exp. Dater / J .. Home Improvement License: /a' " ' a Exp. Date: " f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No. Receipt No.: .. Y NOTE: Persons contracting 'th unregistered contractors do not have access o e g aranty fund o AM t%ORTH own of -% dA--6' ver ® `•: LiAKE h ver, Mass, coc NIc New.cK 5 R^reo I-V' (5 U BOARD OF HEALTH Food/Kitchen PIERM T L �D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .............. ..'..! Ihr.. r.......................................... . ... has permission to erect .......................... buildings on . .. :0..... (Aa-M,�.4!' .. .�f.1,...... ....... Foundation Rough to be occupied as ......... .... ........ ...... ... .... ..................................................... Chimney provided that the person accepting is permit shall in every res ct conform to the.terms of the application Final on file in this office, and to the provisions of the Codes and By-La s 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ® LES CTI A. .. ... Rough Service ...........:... .. . . .... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. sly c r tt`1 ari ' Z 5 i of 'fr G�nl Yt1� j (aog O -10 rq, Expert Masonry Work (Vias('oil ; Licensed h Insured 800_1IV ! 4 lJ'. u> O ,=d i az , , =,�r s= v?.:; � � License#034200 924-8487) }t tom ` i(��j . y ,�� ,d��s =4° r P We owk Year Round Proposal To: Darren Winnie Date 11/17/2015 Street: 160 Carlton Lane 978-906-5116 N.Andover, MA Roof proposal dswinnie@hotmail.com IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect house 12. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. placed under dumpster to prevent any damage to (tarps etc.) Magnets run at final clean up. driveway. 2. Remove all shingles from entire house. 13. Building permit included. 3. Inspect and re-nail any loose or lifted plywood. 14. Contractor workmanship warranty: 10 years under Any compromised plywood will be replaced at normal wind and rain conditions. an additional cost of$55.00 per sheet of 1/2" Total roof cost: $ 12,350.00 CDX fir. 4. Install heavy gauge 8"white aluminum drip Both IKO and Certainteed direct extended non edge to all eaves and rakes. pro rated 20 year fully transferable warranties 5. Install 6' of IKO Armourguard or Certainteed Winter guard ice and water shield along all included in this proposal. Please refer to pamphlets in estimate package. Offered and eaves and top to bottom in all valleys. included in this proposal to our exiting 6. Install IKO roof guard or Certainteed Diamond customers at no additional cost. Deck synthetic underlayment to remaining • Rubber roof: Upon inspection we do not believe sheathing up to ridge. that you need to incur the expense of doing a 7. Install all new pipe boots. Install extra ice and new rubber roof.We will re seal all the seams water shield around any exhaust pipes and all and connections with EPDM compatible seam roof protrusions. tape then apply a liquid EPDM rubber coating 8. Install IKO Leading Edge or Certainteed Swift over the entire area. $900.00 additional cost Start shingles to all eaves. 9. Install IKO Cambridge Limited Lifetime *Note*: Please be advised if applicable, valuables in architectural shingles to entire house. 15 year the attic should be moved or covered due to minor non pro-rated warranty by mfg. 10 year if debris, dust and asphalt particles that will accumulate Certainteed is chosen. All shingles will be during the stripping process. All Under One Roof not installed and fastened according to mfg. specs. responsible for any damage or clean up that may 10. Counter-flash existing chimney lead and wall occur in attic. connections with ice and water shield,tie into new shingles and seal. Balance due upon completion 11. Install a new GAF Cobra ridge vent capped with References available upon request color matched IKO or Certainteed hip and ridge Highly rated member of the accredited BBB and shingles. Anszie's List Thank you! �\ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1/1 t ✓), °� Address: 3 w C City/State/Zip: Phone#: '/ ` °�7�; a' Are you an employer?Check the appropriate boa: Type of project(required): i.®1 am a employer with employees(full and/or part-time).* 7. D New construction i 2.E]1 am a sole proprietor or partnership and have no employers working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'oomp.insurance required.)t 9. ❑Demolition 10 Q Building addition 4.01 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 arc sok 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 1-11 5 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.nRoof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.BOtlter 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§)(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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional shect showing the name of the sub-contractors and state whether or not those entities have employees. 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 employee& Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: `" '.+ L 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$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 pain nd penalties of perjury that the information provided above is true and correct Signature: Date. !z 11_/ Phone#: `1°1 Q0'ieial use only. Do not write in this area,to be completed by city or town qffieiat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrl'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 11/18/2015 WED 11:55 FAX 781 598 6430 DAVID ZELLER INSURANCE 0]001/001 A`C:>R"® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYy) 11/18120 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.ITHIS 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). PRODUCER CONTACT NAME: Maryellen Goodwin DAVID E. ZELLER INSURANCE AGENCY INC PHONE Exit; (781)595-2071 370 LYNNWAY PAX EMAIL AIC No; ADDREss: maryelien@davidzeller,com INSURERS AFFORDING COVERAGE NAIC If LYNN MA 01901 INSURER A: ACE AMERICAN INSURANCE INSURED CO 22667 BERRY FRANK&BERRY JAMES DBA FRANK&SONS INSURER:: -INSURER:: I INSURER D: 45 WINBROOK DRIVE INSURERE: EPPING NH 03042 INSURERF: COVERAGES CERTIFICATE NUMBER: 13141 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, INSR AODL SUeR TYP£OFINSURANPOLICY EFF POLICY EXP LT INSDPOLICYNUMBER MMIODNYYY MMIDD LIMITS COMMERCIAL GENERAL LIAIA BILITY '. EACH OCCURRENCE g CLAIMS-MADE FIOCCUR DA G PREMISES Ea occun.n-I $ MED EXP(Any one person) S NIA PERSONAL d ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECT LOC PRODUCTS-COMPIOP AGO $ OTHER: AUTOMOBILE LIABILITY COM:INED SINGLE LIMB 4ALL NYAUTO Ea accldenl $ OWNED :DOILY INJURY(Perperson) $ '.. UTOS AUTO. N/A BODILY INJURY(Peraccidenp $ IRED AUTOS NON•OWNED AUTOS PROPERTY DAMAGE $ Per accident $ M:RELLALM OCCURWAGGREGATES XCESS LIAB CLAIMS-MADE NIA $DED RE7EN710N$WORKERSCOMP£NSATION SAND EMPLOYERS'LIABILITY YIN A OFFCER/MEMBREXCANYPROPRIETORIPARLUDED ECUTIVE NIA NfA NfA 100,000(Mandatory In NH) 6S62UB9998L43415 11/05/2015 11/05/2016 Il yes,describe under E,L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101,Additional Remark Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired(hose employees outside of Massachusetts. This certificate Of insurance shows the policy in force on the dale that this certificate was issued(unless the expiration date on the above policy precedes the Issue date of this certificate of insurance). The status of this coverage can be monitored dally by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensation/inveutigationst. No partners have elected coverage. CERTIFICATE HOLDER / CANCELLATION D`I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ALL UNDER ONE ROOF ACCORDANCE WITH THE POLICY PROMSIONs. 30 TEMPLE DRIVE AUTHORIZED REPRESENTATIVE METHUEN MA 01844 `)_' Daniel M.Crc v y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD as Massach-usetts•Depaviment of Public SafttV Board of Buitdhig Regulation&and Standards constfi'uefian 59 41�IS33[ •Llaensz: GS-M120 ".� s�•-':G�� fid e 30 TEi1i1�LE DR, V N-� P r NXTfi'f ZN X184 T 1 � • t-.F ��� 3t•ta ti`s �x�hlr>��ltJt1 a�snrrr3sstcsneY C)d V2047 oulifUl nt:ul f6i1RJl •.r' Click on the registration number to view Compltiitit history,You carr also view arhitrion and Ce aranty r and histo The list ( current as of Wednesday, October 8, 2014, Search Results RISNT RESPONSIBLE REGISTRATION ADDRESSEXPI ��DI19 SFATU at.r:.c ml-EK ONE Roor L.ANZAFAME, 137057 166 A MERRIMACK ST 10102/2016 16 Current JOHN METHEUN, MA 01844 42012 Commonwealth of Massachusetts. ---r_ Mass,Gov®is a registered service mark or the cbrnmonweaitti of massashusetts, i.