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HomeMy WebLinkAboutBuilding Permit # 1/5/2016 %AORTPI BUILDING PERMIT 6,t TOWN OF NORTHA OV R 0 APPLICATION FOR PLAN EXAMINATION Permit No#: (Sl- Date Received Date Issued: & IMPORTANT: Applicant must complete all items on this page LOCATION 17 9 -1�all /,A(,P 1 o Print PROPERTY OWNER 6kh r) 4/--1 Print 100 Year Structure yesno MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside tial Non- Residential El*New Building P,16ne family El Addition El Two or more family El Industrial El Alteration No. of units: El Commercial repair, replacement El Assessory Bldg El Others: El Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: ffii2 VL SIO 0 Ci Pee,r, A "IC,6 4 Ir— /zcx,, C Identification- <Please Type or Print Clearly OWNER: Name: (/7-/07�) �% -Y,7 ue- Phone: 0 Address: Contractor Name: 6,"i;q 11'wze&y Phone: Email: CkAl Address: L111q1,61eAe,4-Q Z"A+ 01Y'll Supervisor's Construction License:CS - 10721'7 -Exp. Date: Home Improvement License: f3 7U, '7 Exp. Date:. Z�!- Z17,6201,1,, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGPERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00PER S.F. S- 0 FEE: Total Project Cost: $ 11, 74, $ Check No.: Ill 3.5 A Receipt No.: NOTE: Persons contractin ith tinre d contractors do not have access to tlae ar fund fthat �1 U7 N®RTH Ajtjtuu V UF No. `7 % 1- 2�bl h AvI.Mkei LAKE ver, 6.l.SS.� C OCHICHE WICK y1. �d A�RATEO S U BOARD OF HEALTH PER T L �10 Food/Kitchen Septic System THIS CERTIFIES THAT ............. ........N....[ A...... ........................................... ...................................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ........ .....,.....Q !• R`i'!•v••••• ••••v....... . Rough tobe occupied as ....... ........ ....... ........... .... .. T....:..... ...•;•�•T.... ...... .... .. Chimney provided that the person accepting this permit shall in every respect co m to the terms of the ap a ' n Final on file in this office, and to the provisions of the Codes and By � � ���� ���� �� �U.S. Roofing � �� I= 11110101UGdivision nfBuilding Maintenance Corp 0�m....MONF![). Box 3118 Peabody, K8A018G1-3118 nC3C3F1PJC3 Telephone: /978\ 532-03O0 Fax: (978) 977-0803 � CONTRACT The Owner(s) ofthe premises described below ("JobAddress"),hereby contract with and authorize U6. � Roofing, a division of Building Maintenance Corp. ("Contractor"),to furnish all necessary materials, � supplies, labor and workmanship,and to install, construct and place improvements at said Job Address, � accordinqtothe fo||owinnsoeciflcations. terms and conditions: � 1. Glenn D. Charnue| 97Palomino Drive North Andover, y4AO1845 2. Job Address: 97Palomino Dr'. North Andover, MAO1845 3. bReciticarigons t_oDoraCumragrees mm peiVUrmm Iduerohuwv\ng Serv/Ces In a ymwu | and workmanlike manner: (Rear Main Roof/Rear Garage Roof only) — Remove all existinq oh|nV|e lavers down tm exposed wooden nmofsheathinQ; replacing up to 32f2 included in project — Dispose ofall roofing debris inalegal |andfl|| — Install six-foot (61 widths; |hc|udinq valleys, roof penetrations — Nail Deck-Armor rm Breathable Under|aymment over remaining roof surfaces — Install 8" aluminum drip edge to all applicable roof perimeters (rakes & faycial — Install GAF T" Tirnbar|ine& HD Architectural shinq|es to all roof surfaces; storm nai|ingeach (sixnailsperah/no/e) — Install Cobra0D roof ridge vent at peak locations for ventilation ofattic spaces if applicable — Flash all existing roof penetrations including providing and installing all new plumbing vent pipe flanges according toNational Roofing Standards — Cap ridQegxvith GAF`" TirnbertexO Architectural Hip 8kR|dqashinq|ea — Secure and clean all existing gutters at completion of project 4' Possible Alternates: Minor sheathing replacement: Existing rotted sheathing or board replacement cost(if needed above and beyond 32ft2) would be aub1ecttoenadditional cost$4.OU/ft.2 S. Warranties:� The above work comes with a GAptm Roof Material Warranty (furnished to Owner from GAFtm direrHir) 6. Payment Terms: The Base cost ofthe contracVs $ 4,Y35.QU Pkmentaha\| be rendered in the following manner: To be billed on oarcentaqecomcdeUon basis: 10096 dueupon successful como<eUon of all work; 7. lnthe event ofdefault, the Owner shall pay costs for collecting amounts owing including, without limitation, court costs,expenses and reasonable attorney's fees, in addition toanvsum that the member mavbecalled ontopay. | | S. This bact constitutes the entire agreement between the rtid any | prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. The Owner aqrees that Contractor has made no statements, promises,commitments or reoresentations not onv,amnixpnpm. � � � � 9. Modification: Other than that required asaresult of paragraph 4above, any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if evidenced in writing signed by each party nran authorized representative ofeach nartn. � � 10' Contractor|snot liable for delays due Uoweather, strikes, accidents, � acts of God or other circumstances arising out of causes beyond its reasonable control and without its fault ornegligence including but not limited to: interior damages, Ice damming due tnpre' � ex|sbn000ndiUons: i.e. /ackofnoo[venU!atinn. hotaoWsorunma|ntainedsnoworice /oads. 11' Itisagreed that this agreement shall be governed by, construed, and enforced /nnrrn,na"rpwith 1-xp/=wqnro`prnmmnn,vea/rhorwasracm.qenp IN WITNESS WHEREOF, the parties have signed their names hereto: De+e� 12-9-201S Dntp- � U.S. Roofing, by' its agent, Owner or Owner gent: Michael S. Murray Printed Name: Glenn D. Chamuel List desired shingle color: TAMKO Architechtural Weathered Wood (Please Print) 7 � The Commonwealth of Alassachusetts Department ofIndustriatAccidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers,Compensation Insurance Affidavit:Builders/Contractors/Electriciansprint L bens PleasWMY Applicant Information Name(Business/Organ tzation/Individual): l Ll ���� Address: City/State/Zip: , d `lb I Phone 4: T7 6 - '31 Type of project(required): [3. 1 n employer?Check a appropriate box: general contractor and I to er with� 4. ❑ I am a g 6_ ❑New construction a emp y have hired the sub-contractorsoyees(full and/or part time)_* 7. []Remodeling listed on the attached sheet. a sole proprietor or partner- These sub-contractors have 8. ❑Demolition and have no employees employees and have workers' 9 F1Building addition ing for me in any capacity. comp_insurance J IO.E]Electrical repairs or additions workers' comp.insurance 5DJe are a corporation and itsired.] officers have exercised their 11.C7 Plumbing repairs or additions a homeowner doing all work right of exemption per MGL l2.�Roof repairs er elf_[Noworkers' comp. c.152,§1(4),and we have no 13rance required.]fi employees.[No workers' "`� comp.insurance required.] * applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Any app are doing all work and then hire outside contractors must submit a new afrrdays indicating such - *Any Homeowners who submit this affidavit indicatingtheY _ $Contractors that check this box must attached an additional[ectt rsho their he nam f the sPolicy n"r"ber.�d state whether or not those entities have. employees. If the sub-contractors have employees,they mus ! f y P y policy ob site I am an employer that is providing workers'compensation insurance or nt em to ees. Below is lute oli and] information. _ A Fh,C_U �,;i,G r Insurance Company Name: -i=. 2 i i L Expiration Date: 3 a0/ Policy#or Self-ins.Lic.#: Fl�� ✓ Job Site Address: l CCS r~i I « it V City/State/Zip: / ^ Gt of the workers' compensation policy declaration page(showing the policy number and expirafion date)_ Attach a copy penalties of a Failure to secure coverage as required under tSectlon25W 11 as civil penalties m the tothe e o a STOP WOORDER of d a fine fine up to$1,500.00 and/or one-year imprisonment, of this statement may be forwarded to the office of up to$250.00 a day against the violator. Be advised that a copy Investigations of the OIA for insurancegoverage verification dial the information provided above is true and correct: alties o er ury I do hereby certify er the pain an p l Date: Si afore' J._ Phone#: official use only. Do not write in this area,to be completed by city or town official. PermitlLicense##_ City or Town: Issuing Authority(circle one): cut 3.City/Town Clerk 4:)Ctectrical Inspector 5.Plumbing Inspector 1.Board of Health 2.Building Departm 6.other - _- - _ Phone#: -- Contact Person- � C"I? ° CERTIFICATE OF LIABILITY INSURANCE DAT2/2112D/YYYY) 12/21/2015 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(ies)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). Op PRODUCER 06175-001 NAMEAECT Branch 6175-1 TDA Inc dba The Driscoll Agency AICNNo.Ext: (781)681-6656 FA/C.No.: (781)681-6686 93 Longwater Circle EMAIL Norwell,MA 02061 ADDRESS: ksei p@driscollagency.com INSURERS)AFFORDING COVERAGE .__ NAIC# INSURERA: A.I.M.Mutual Insurance Company g INSURED INSURERS: Building Maintenance Corp --- US Roofing INSURERC: _ P O Box 3118 INSURER D. Peabody, MA 01961 INSURER E: 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 COLLAIMMSS. ILTR TYPE OF INSURANCE AI<VSR W1/BU POLICY NUMBER MM/DDY� MM/DD/YYYY LIMITS '.. GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Ea occurrences CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL R ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY ECT OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY ALTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIABOCCUR EACH OCCURRENCE $ '.. EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ yyC g 77 $ AND EMPLO COMPENSATION N A TIOTNY -- -- X TORY LAMITS OER ',.. ANy PRp PRETpR/PqR TN ER/EX ECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000,00 A oFFICER/M�MBEREXCLUDED$ N/A VWC-100-6018031-2015A 12/23/2015 12/23/2016 (Mandatory In NH) ee�� E.L.DISEASE-EA EMPLOYEE $ 500,000.00 DE sCRIPTI�A V9PERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town Of North Andover 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD A� ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/YYYY) 12/22/2015 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(ies)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: The Driscoll Agency, Inc. P"°NE 781-681-6656 FAX 781-681-6686 93 Longwater Circle E MAIL (A/c, ° Norwell MA 02061 .jbd@driscollagency.com INSURERS AFFORDING COVERAGE NAIC# INSURERApAIM Mutal Ins Co 33758 INSURED 3327 INSURERB:Acadia Insurance Group, LLC 31325 Building Maintenance Corp. INSURER C:Peerless Ins Co 24198 dba U.S. Roofing INSURER D:Navigators Specialty Insurance Com PO Box 3118 Peabody MA 01961 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:263404672 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MWDD/YYYY B X COMMERCIAL GENERAL LIABILITY Y Y CPA 5232495 12/23/2015 12/23/2016 EACH OCCURRENCE $1,000,000DAMAGE To '... CLAIMS-MADE X1 OCCUR -PREMISES(E.occu soca $250,000 X XCU MED EXP(Any one person) $5,000 X Inc Contractual PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY rX]JEC [X]LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ I C AUTOMOBILE LIABILITY Y Y BA8730382 12/23/2015 12/23/2016 COMBINED SINGLE LIMIT $1,000,000 '.. Ea accident ANY AUTO BODILY INJURY(Per person) $ '.. ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $ HAUTOS Per accident D X UMBRELLA LIAB X OCCUR ISI5EXC8590761C 12/23/2015 12/23/2016 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$O $ A WORKERS COMPENSATION Issued by Carrier 12/23/2015 12/23/2016 PER ETH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Installation CPA 5232495 12/23/2015 12/23/2016 Job Site Limit $100,000 Floater Leased Rented Equip $180,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:58-60 Edgelawn Ave., North Andover MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Building Department 1600 Osgood St. AUTHORIZED REPRESENTATIVE North Andover MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 9714(7- -Al � ea __�jn—yoffice of Consumer Affairs and Business Regulation L li'_ '91 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 137667 Type: Private Corporation Expiration: 1211712016 Tr# 260114 BUILDING MAINTENANCE CORP. ----- "- PETER ALLARD P.O. BOX 3118 PEABODY, MA 01961 _.-- ---- ----- Update Address and return Gard.Mark reason for change. Address F-1 Renewal J Employment i_ Lost Card scA Zorn-osn, I r/l�• t<ndi�n�-i,tnrnl/�n r'llo�ar�t<Jc((� - License or registration valid for individul use only Oflicc of Consumer Affairs&Business Regulation before the expiration daft. If found return to: m gOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation y ., Type: 10 ParkPlaza-Suite 5170 I � Registration: 137667 private Corporation .Expiration: 1?J1712016 Boston,MA 0211b BUILDING MAINTENANCE CORP. PETER ALLARD --_-_-- a..6.._-x ---fir-- 1415 WILLARD ST g ---- _--- PEABODY.MA 01960 Undersecretary Not valid without signature 'I 'I i I Unrestricted-Buildings of any use group which q Massachusetts -Department Of PUbhc Safety contain less than 35,000 cubic feet(991M )of Board of BuHding Regulations and Standards enclosed Sp1C�. Conwtruction�raapercisor Ucense: C;S-107719 CRAIG MURRAY 48 PITMAN ROAD Marblehead MA D1945 Failure to possess a current edition of the Massachusetts I = State Building Code is cause for revocation of this license. „ ,, Exp ritiory For DPS Licensing information visit: www.M:ss.Gov/DPS 06/08/2017 �f I I