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HomeMy WebLinkAboutBuilding Permit # 1/11/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER � `j1_ 46- ®tot APPLICATION FOR PLAN EXAMINATION _ Permit No#:'0A -4(/ Date Received �Ss�cwus�� Date Issued: IMPORTANT: Applicant must complete all items on this page � / r r r I ! 1 � i r r rrr �i�i r�:rr /rrrri r n J r LI+W liA N / it / r r r / �r�/ ✓r/� r / r TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building vone family ❑Addition ❑ Two or more family ❑ Industrial ❑ teration No, of units: ❑ Commercial Qepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other / r S e tl / ❑ f / / r r, / /1,„ !,�/�,// / / / ✓ r i/,,/ / � / / / � DESCRIPTION OF WORK TO BE PERFORMED: Ide ti cation- Please Type or Print Clearly OWNER: Name: Phone �� Address: r r r r / /l ✓ r ,rer r r it e / / / / / r .,, / r / riErnall.r���/l�//�������f���/,/�////� f,//c/%/l�/��il�/if :✓//,,,i�/f/��///////af��//.//, /i���il/�/ll�r r � r/r r r r ,; r r JM ARCH ITECT/ENGIj,4EE�R_ Phone: Address: Reg. No. FEE S —E V E.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ,r FEE: $ r ° Check No.: _.�e.�a._e.w: Receipt No.: C;��Clo(9-- NOTE: Personi ratting wit unregistered contractors do not have access to the guaranty fund � �.. .� 9 ,Sgnatureof_contractorm 'Signature of Agent/O ner ._„µ F ttORTH of , -Andover 0 . No. q1— L am• o ���� h ver, ass, COC HICMCWICN �• �p S V BOARD OF HEALTH Food/Kitchen PERMI �T , T LD Septic System THIS CERTIFIES THAT ..�. ................... ,,, ,. .... BUILDING INSPECTOR . .................... . .... .......................................... has permission to erect .... buildings on .. .... .� . Foundation ...................... ........ ......... ............ ......... . Il ..... Rough tobe occupied as .................. .. ... ........... .........III........... . ....................................... Chimney .provided that the person accepting this permit shall in every respect confo 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 Final ® PERMIT I IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTS TS 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 by the Building Inspector. Burner Street No. Smoke Det. Proposal b"Ir AB Carnes Roofing,Inc. 2-041, 30 Arrowhead farm Rd yw,, dge I of I Boxford,Ma.01921 978.887-1431 MA.CS-000230 and HIC Reg.176928 Proposal Submitted To: WILLAIM&KELLY SILVA Date October 26,2015 17 SUGARCANE LN Project Name SAME NORTH ANDOVER,MA 01845 Address 978-557-5728 We propose to fumish material and labor-in accordance with the specifications below: Twelve Thousand Three Hundred Dollars($12,300.00) Payment to be made as follows:$300.00 Deposit,Balance Uponj Completion Notice:All home improvement contractors and subcontractors engaged in home improvement contracting,unless specifically exempt from registration by provisions of Chapter 142A of the General Laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and status should be made to the Mass.gov/llcenses website. ROOF PROPOSAL STRIP ROOF OF ALL LAYERS OF ASPHALT SHINGLES,COVER ROOF DECK WITH THE UPGRADED RHINOROOF TITANIUM U20 HIGH PERFORMANCE SYNTHETIC UNDERLAYMENT MEMBRANE.COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. ICE DAM PROTECTKft INSTALL CARLISLE HIGH PERFORMANCE ICE&WATER BARRIER OVER ALL HEATED AREAS SA FELT WIDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THE CHIMNEY(S)AND SKYLIGHT CURBS WITH ICE AND WATER BARRIER. r,Rj COVER ALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. rX—i INSTALL GAF COBRA RIDGE VENT AND/OR[--] ROOF LOUVERS FOR ADDED ATTIC VENTILATION. COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE, REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF$25.00PLF'r.WE MAY NEED TO REMOVE THE SIDING TO PERFORM THIS WORK AND YOU MAY NEED TO HAVE A CARPENTER REINSTALL OR REPLACE THE SIDING THAT WAS REMOVED. 0 CHIMNEY HASHING.CUT ALL EXISTING TAR AND LEAD FROM ONE QHIMINEAS).CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS, PROPERLY rS -IR9GLEhOI T. PLEASE ADD$4,1301,00 TO ABOVE PRICE. -1 COVER ROOF SURFACE WITHGERTAlNTEED LANDMARK24 �B 11_ �:TIME WAR'T NTY DESBGNER SHINGLES,, _11 F'� it AT REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH SIMILA ATAN-ADDITONAL COST OF$4,GOPSQFT. F—) COVER ROOF DECK WITH CDX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF Z NAILINGSECURE SHINGLES WITH EIGHT IN TOTAL COATED ROOFING NAILS AS PER CERTAINTEED SPECIFICATIONS. 0 SKYlLiGHTS.'REPLACE EXISTING SKYLIGHTS WITH NEW VELUX OR WASCO UNITS.WE WILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.OUR LABOR CHARGE IS$75.00 EACH IF THEY ARE THE SAME SIZE.INTERIOR WORK IS EXCLUDED. 0 REMOVE EXISTING GUTTERS Fj INSTALL NEW SEAMLESS,032 ALUMINUM GUTTERS USING THE HIDDEN ZIP SCREW HANGER SYSTEM. 0 REPLACE DEFECTIVE TRIM BOARDS WITH CUSTOMERS APPROVAL USING NO.2 PRIMED PINE,ADD$15.00PLF'r TO THE ABOVE PROPOSAL. E] INSTALL NEW ALUMINUM DOWNSPOUTS AND MECHANICALLY FASTEN ALL CONNECTIONS. CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA.THE PROPERTY OWNER AUTHORIZES AB CARNES ROOFING TO OBTAIN ALL PERMITS.WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS. CUSTOMER SHOULD COVER VALUABLES. GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE.HOWEVER,SOME MARRING AND OR MINOR DAMAGE COULD OCCUR. IN ADDITION,WE CANNOT BE RESPONSIBLE FOR ITEMS FALLING FROM WALLS,SHELVES OR CEILINGS DURING THE ROOFING PROCESS. SPECIAL INMUCTMS.' THE ABOVE PROPOSAL INCLUDES ALL SHINGLED ROOF SECTIONS OF THE HOUSE. SHINGLE UPGRADE:UPGRADE TO THE LANDMARK 300LB HIGH DEF PREMIUM SHINGLES,ADD$1705.00 YES( )THIS IS OUR EXACT COST WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WIT AN UPGRADE TO THE CERTAINTEED HIGH 'ERFORMANCE HIP RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.' 6 EMAIL ADDRESS. CV, Warranty:All work warranted against installation defects for 5 years;this warranty is limited to the installed item(a)and its repair only.Material is warranted by the manufacturer against defects for 50 years;see the manufacturer's warranty for exact warranty performance. Caflcoliati=Customer has legal right under federal law to cancel this contract without penalty or obligation within three business days from the date of signing this agreement via Priority Mail Delivery Confirmation. Please see reverse side. Dispute Resolution under l0assachUSettS Home improvement Law 142a:All parties agree that any and all disputes relating to this proposal shall be settled by arbitration.This forum' /js,,user friendly and does not require lawyers.Please see reverse side. Signing this Proposal mearis,yju have accepted all the terms as stated on the front and back of this agreement. Please see reverse side. *Date of Acceptance Signature *Signature Signatu PLEASE SEE REVERSE SIDE TOWN OFN TH ANDOVER WASTE AFFIDAVIT As a result of the provisions of MGL Ch.40-s54, I acknowledge that as a condition of building permit# all debris resulting from the construction activity governed by this building permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL Ch.111-s150A. Waste Disposal or Solid Waste Facility: ALLIED WASTE Address: 300 FOREST ST Town/City, State, Zip: PEABODY, MA 01960 NAME OF HAULER: AB CARNES ROOFING, INC. DUMP TRUCKS DATE: 1-11-2016 s� SIGNATURE OF APPLICANT: - '" M The Commonwealth of'Allassachusetts Department of IndustrlalAccrdents Y' 1 Congress Street,Suite 100 " Boston,MA 02114-2017 ata ' www.nzass.gov/dta Wurkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information _ Please Print Let=ibly Name(Business/Organization/Individual):AB CARNES ROOFING INC Address:30 ARROWHEAD FARM RD City/State/Zip: BOXFORD, MA 01921 phone#:978-887-1431 Are you all employer?Check the appropriate box: Type of project(required); 1.0 I am a employer with some employees(full and/or part-thue).* 7, El New construction 2.0 t ani a sole proprietor or partnership and have no employees working leer ore in 8, [] Remodeling any capacity.[No workers'comp,insurance required.) 9. El Demolition 3.[]l tau a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑[am a homeowner and will be hiring contractors to conduct all work ora my properly. 1 will 10 n Building addition ensure that all contractors either have workers'aornpensation insurance or are sole l I.E]Elee trical 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 tire attached sheet. These sub-contractors have employees and have workers'comp.insurance.$ 13.W]Roof repairs 6.❑We are a corporation and its officers have exercised then-right ol'exemption per MGL C. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also till out the scotion 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 subnut a new affidavit indicating such. tConuactors that check this box must attached an additional sheet showing the name of the sub-contractors and suite whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, L ane an employer that is providing tvorkct.v'eoittpensatioii insurance for hey employees. Below is the policy and job site inforuttrtiun. G TRAVELERS INDEMNITY CO OF AMERICA Insurance Company Nant " — -_ — -- -- Folic #or Soli`=it s.Lic.#:._ Expiration Date:10/15/2016 a Policy 4 6HUB-OG36156-6-15 -.._ ----�_--. Job Site Address:.--_.. _ _.. —-- -- — ---- ---City/Stake/'Lip: 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 tine 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 line of up to$2SO.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. _ fy f[ j fbrneatiurr provided above is frac arrt!correct. I tl herb cera un thr tf""' ury that the to 3' p P !us cold cant tec�u ter _.__.. -- --- � - —Date Phone 0:078-887 1 31 Official use only. Do not write in this area, to be completed by city or town official. City or Town:__-- -------......_..._._ Permit/License# Issuing Authority(circle enc): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector ti.Other Contact Person: Phonle#; ACC. 0 CERTIFICATE LIABILITY INSURANCE DATE(MM/DDIYYYY) 1/11/2016 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: BRIAN L. PRESCOTT&SONS INS PHONE FAX AIC No Ext): AIC No): 963 EASTERN AVE E-MAIL ADDRESS: MALDEN,MA 02148 w INSURERS AFFORDING COVERAGE NAIC# INSURER A; INSURED "^" AB CARNES ROOFING INC INSURER B: Travelers Indemnity Company Of America 30 ARROWHEAD FARM RD INSURER C BOXFORD,MA 01921 INSURER D: INSURER E: '.. ae , 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 CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DA A E T RE TED COMMERCIAL GENERAL LIABILITY FF PREMISES Ea occurrence $ CLAIMS-MADE �OCCUR MED EXP(Any one person) $ PERSONAL SADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR F F EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION TOC STATU- OTH- AND EMPLOYERS'LIABILITY YIN, R hLIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE I;r,`I N I A 6HUB-OG36156-6-15 10/15/2015 10/15/2016 E.L.EACH ACCIDENT $ 100,000 OFFICE/MEMBER EXCLUDED? �`t\�V—'� (Mandatory In NH) E.L.DISEASE-Fly EMPLOYE $ 100,000 if yes,describe under F,L:'CISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ROOFING CONTRACTOR CERTIEICAT' HOLDER CANCELLATION WILLIAM SILVA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 17 SUGARCANE LANE ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER,MA 01845 AUTHORIZED REPRESENTATIVE Brian N.Leary,PRESCOTT&SONS INS ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD NOTICE 1z" UJ NOTICE TO > 0 TO EMPLOYEES CC EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS I Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-727-4900 — http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P .O. BOX 1460 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (6HUB-OG36156-6-15)� 10-15-15 TO 10-15-16 POLICY NUMBER EFFECTIVE DATES PRESC&T & SON INS 963 EASTERN AVE MALDEN MA 02148 NAME,,OF INWRANCE AGENT ADDRESS PHONE # AB CARNES ROOFING INC 30 ARROWHEAD FARM RD BOXFORD MA 01921 ,EMPLOYER ADDRESS 0= EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of 0= employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 000B49 W20PIG15 TO BE POSTED BY EMPLOYER � r✓�n /Y`'r,✓�d✓J'la{/F/i�a���J'f+`�� �ls`dJclt'R�Jrr'.da^/A;e Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 176928 Type: Expiration: 10/10/2017 Corporation a AB CARNES ROOFING, INC. BARRY CARNES 30 ARROWHEAD FARM RD BOXFORD, MA 01921 Undersecretary Massachusetts , Department or Plutfl¢c Safety Bowd of d"uddifng Vteq,lWaboiro w4 and St n darca f°"nstructtutw upetTMvoof L.:r,a dti scrt: CS-000230 BARRY S CARNES 30 ARRO"WHEA16 A0 �m ew Boxford MCA 01921 ,rFh ;a A 1u u w uasso a 11 n e 03/07/2016