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Home My WebLink AboutBuilding Permit # 12/15/2015 .................... BUILDING PERMIT %AORTH ,,eD TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#- Date Received Date Issued: I V�I I IMPORTANT: Applicant must complete all items on this page LOCATION -5,int PROPERTY OWNER C Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family 11 Addition L1 Two or more family 11 Industrial 0 Alteration No. of units: El Commercial El Repair, replacement 0 Assessory Bldg El Others: El Demolition 11 Other ...... pr/ri,e 0 1 ❑� '�/� � � , �� , rr� �/i � �t r l/ l�ter �, /� DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: IL,4 A/-,k, Phone: Address: Contractor Name: 1, i'lkvj WI,4a11 Phone: Email: Address: 6-4-cTTO -e-q ",gww-,f Supervisor's Construction License: Exp. Date: �. 1-3 z Home Improvement License: o Exp. Date:- C, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00PER S.F. —� , C� C;, Total Project Cost: $ 0 1FEE: $ Check No.: 4 Receipt No.: 24� NOTE: Persons contracting wt unregistered contractors do not have access to the guaranty fund io "Siq, at A -an g ner, FORTH Town of N Andover o ;moi. "K �O LwKa h ver, Mass, C0C"1CHew1cx 1_ SRATED P"P��S V BOARD OF HEALTH � RMI �T �T� L u Food/Kitchen Septic System THIS CERTIFIES THAT ..............(&A&C........ . . ........................................................................ BUILDING INSPECTOR Foundation has permission to erect.......................... buildings o ....... . ........ ... ........................ Rough to be occupied as .............. .. .. ..... . ........ ........................ ........................................................... Chimney 4/100 provided that the person accepting th permit shall in every res 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 I I IM ELECTRICAL INSPECTOR LES CT Rough Service ............. ...................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BuRough 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. �Init4at! }' gag '}fcnC Ci{' 1i 9 ASS" Al I Types Of i�f �ri;�3t4 tta �e t d` lhfi:i-�'E' � � �a [.; �Na,� �_ } "7� Expei Masonry Work �ii61i 11gi Cleansed & Insured rglass Toll F'r&p_ I.nritlt} C3wtrd y :3!> rat<i1.5 lU.l!f � e y LIC@nSB#034200 1_800-WAIT-4-US "w �7e7es¢lc ¢as $ cstiarna$ (324-8487} '�:.' Proposal To: Marc Perry Date 9/17/2015 Street: 507 Salem St. 978-975-8237 North Andover, MA Roof proposal marc@perryins.com 1. Protect house exterior and landscaping as best as 16 IKO Shield Pro Plus Extended mfg.warranty: possible. (tarps etc.) 100% coverage, fully transferable, on material, 2. Strip all shingles from entire main house. labor,tear off and debris removal for a full non 3. Inspect and re–nail any loose or lifted plywood. pro-rated period of 20 years. Offered to our 4. Any compromised plywood will be replaced at an referred customers and included in this proposal at additional cost of$65.00 per sheet of 1/2" cdx fir. no additional cost. 5. Install heavy gauge 8" aluminum drip edge to all eaves and rakes. Total cost: $ 5,900.00 6. Install 6' of IKO Armourguard ice and water shield along all eaves and top to bottom in all Notes: Please be advised,valuables in the attic valleys.. 6'MA state code. should be moved or covered due to minor debris, 7. Install all new pipe boots. dust and asphalt particles that will accumulate 8. Above the ice and water shield, install IKO cool during the stripping process. All Under One Roof roof guard synthetic underlayment to the not responsible for any damage or clean up that remaining sheathing up to the ridge. may occur in attic. 9. Install IKO Leading Edge shingles to all eaves. 10. Install IKO Cambridge AR(algae resistant) Limited Lifetime architectural shingles to entire Balance due upon completion roof. 15 year non pro-rated warranty by IKO mfg. 11. Install new Cobra ridge vent. Referrals available upon request 12. Counter-flash chimney and all roof protrusions with ice and water shield, seal and tie into new Highly rated member of the accredited BBB and roof. Anizies' List 13. Building permit included. 14. Removal of all work related debris. Thank you! 15. Contractor workmanship warranty=10 years under normal wind and rain conditions. Acceptance of Proposal—The above prices, specific ions and condi ions are satisfactory and are herby ac- cepted. You are authorized to do the work as specified Payment will b ade outlined above. f ur a Date of Acceptance: IJ/ Signa � .C\ The Commonwealth of Massachusetts QVIWO Department of Industrial Accidents I 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. Apulicant Information �1 Please Print Leeibly Name (Business/OrganizatiorvWividual): 411 ltna—•l 60"(- Address: 0 Address: City/State/Zip: f--,-�� w-%A-J-S Phone#: Are you an employer?Cbeck the appropriate box: Type of project(required): I.Q 1 am a employer with employees(full and/or pan-time).• 7. ❑New construction 2.E]1 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 myscl[[No workers'comp.insurance required.)t 1 Demolition 10 Q Building addition 4.[]]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 arc sok 11.[]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 54 I am a general contractor and I have hived the sub-contractors listed on the attached sheet. 13.E]Roof repairs These subcontractors have employees and have workers'comp.insurance.t 14.®Other IZv Y–' 6_D We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(41 and we have no employees.[No workers'comp.insurance required.] 'Any applicant that chocks 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 trust attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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 information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: �r� $�' ��'"� S /J9� 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and enalties ofperjury that the informadon provided above is true and correct Si ature: a Date: Phone#: 9 O,,()`icial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 11/18/2015 WED 11:55 FAX 781 598 6430 DAVID ZELLER INSURANCE 10001/001 A�O�'D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM)DDIYYYY) 11/18/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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: Ma ellen Goodwin DAVID E.ZELLER INSURANCE AGENCY INC PHONE Ext: (781)595-2071 No; AnDR1ESS: maryellen@davidzeller.com 370 LYNNWAY INSURERS AFFORDING COVERAGE NAICtI LYNN MA 01901 INSURERA: ACE AMERICAN INSURANCE CO 22667 INSURED INSURERS: BERRY FRANK&BERRY JAMES DBA FRANK&SONS INSURERC: INSURER D: 45 W INBROOK DRIVE INSURER E: EPPING NH 03042 1 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 !,W. $UB POLICY EFF POLICY EXP LTR TYPEOFINSURANCE POLICYNUMBER IMMIOD M)OD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS•MADE F OCCUR DA EED PREMISES Ea occurrence S MED EXP(Anyone person) S ; N/A PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 1-1 jEQ FILOC PRODUCTS-COMP/OP AGO $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANYAUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED N/A BODILY INJURY Per accident $ AUTOS AUTOS ( ) '.. NON•OWNEO PROPER TYDAMA E HIRED AUTOS AUTOS (Per acctile, $ $ UMBRELLALIAB OCCUR EACHOCCURRENCE S EXCESS LIAB CLAIMS-MADE N/A AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION ERoTH- AND EMPLOYERS'LIABILITY YIN X T UTE ER A OFFCER/MEM EREXCLUDED?ECUTIVE WA NIA NIA 6S62UB999BL43415 11/05/2015 11/05/2016 E.L.EacHAcctDENT S 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 100,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT s 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS]VEHICLES(ACORD 101,Additional Romartrs Schedule,maybe attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant 10 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 those employees outside of Massachusetts. This Certificate of insurance shows the policy in force on the date 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 daily by accessing the Proof of Coverage-Coverage Verification Search tool at mvv/.mass.gov/iwdAvorkers-compensatiordinvesligations/. No partners have elected coverage. CERTIFICATE HOLDER CANCELLATION ` 6 ` Q L/6 V! 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 PROVISIONS. 30 TEMPLE DRIVE AUTHORIZED REPRESENTATIVE METHUEN MA 01844 �"' Daniel M.Crt 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 Massachusafts.Depwiment of Public SaWy Board of Building Regulations and Standards Ccs"'5Bruei#ar€ s�cr�i�atie t_icens*.- CS4M1{20 NIP ' {#�� { ' ' �,�• 1 30T"IPLE DA MTRUENMA X18# {n� ' Upiration commissioner W=20i? '... .�e�+rc:n r�cyaua�w� Click on file registration number to view complaltit history, You can also view arbitrati n and Quarantv Fund histo The fist ► current as of Wednesday, October 8, 2014, j` Search Results REG � 11 T RESPONSIBLE REGISTRATIONINDIVIDUAL NUMBER �f31mRE i~➢CPiRATICDCt? STATUN; DAA ALL UNDeft OM Roof- L.ANZAFAME, 137057 166 A MERRIMACK ST 10/02/2ol5 Current, JOHN METHEUN. MA 01844 02012 Commonwealth of Massachusetts. M©SS.GovO Is a registered service°mark or tha cortinionweam of Massachusetts,