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Home My WebLink AboutBuilding Permit # 4/6/2016 %AORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 Permit No#: (I)II115,b Date Received ,?,TED Cl Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �,.r" ((k Print PROPERTY OWNER mwliTZ Print 100 Year Structure yes no MAPS PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El,New Building rv' One family Li Addition El Two or more family U Industrial `Alteration No. of units: 11 Commercial El Repair, replacement El Assessory Bldg 11 Others: 11 Demolition 11 Other C"raldg/, VV 4`1 �6/,//d s m 'bi" e W NMr.10 I DESCRIPTION OF WORK TO BE PERE:r'RMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: -) ls,� ftf�( Look" Contractor Name: Jkc,YPhone: �11&1 -6-1(--klcwll L Address: Supervisor's Construction License: Exp. Date. Home Improvement License: Exp. Date: -JI 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: $ FEE: $ Check No.: L, Receipt No.: NOTE: Persons contracting with unregistered contractors (to not have access to tz k a1 arty fund Si a ire cif Agent/Owner Signature of,contractors rim NORTH kywill 11do V Cf )2 t-n h ver, Mass, 1-116 � ®S coCHICHEWICK ��• RATED P"PA�� U BOARD OF HEALTH ERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT �< //„u�a BUILDING INSPECTOR .............. ........ ......................................................:............................................ � `SE s Foundation has permission to erect .......................... buildings on ............................................ ................................. 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 PERMIT l I 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .................. ..... . .!l/..��.............................. BUILDING INSPECTOR Final GAS INSPECTOR ccupancy Permit Required to Occupy Buildin 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. r. EIN#51-050-3313 Haverhill MA 978.374.9224 MA Reg.HIC#149221 ambe Lawrence MA 978.687.7339 MA Lic.UCS#78130 Hampton NH 603.929.9224 ®�fi�� Hampstead NH 603.329.8200Sin le-PI License#1711 SCiz932 �, Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 cLicensed vinsured _;Factory Trained Factory Certified Name: Date: / Telephone ''' > Alt.Telephone: Email: BillingAddress166 Mipoks S�- City: r er- State: Job Address: City: State: Scope of Work Astrip and Re-roof ❑Re-roof Approximate Roof Area: 0 Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. ❑ Remove existing layers of shingles down to roof deck and dispose of in a legal fashion from the 'ob site. El Inspect wood deck,if we discover any rotted wood, replacement will will performed at*$ 5- per LF for roof deck boards. If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ 1 , 2—Q per SR If individual sheets are found to be rotted/or de-laminated,removal,disposal and replacement will be performed at*$ per sheet. If any trim boards are rotted, replacement will be performed at*$ 1 �' per LF for new pre-primed pine. Inspect siding at roof line and all flashing behind siding,if we discover any damaged flashing or siding at the roof line,replacement will be performed at .If wood deck,siding,and flashing is sound,we will re-nail any loose wood to rafters,sweep deck,and prepare for roofing. ❑ Install 8"drip edge to all rakes and eaves.Color I I f f El Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/ord�( ' ❑ Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. ❑ Re-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness. ❑ If upon inspection,we discover chimney lead to be worn or deteriorat d,re lacement will be performed at*$ V2 5, . ❑ Install a new: Year ❑ Traditional chitectural ❑ Designer Color ❑ Furnish and Install a new shingle over style ridge vent system ❑So rt vent system*$ ❑ All debris generated by Lambert Roofing Co.,Inc.will be cleaned up and disposed of from the job site in a legal fashion.Under no circumstances will the waterti ht integrity of the building be compromised. Special Notes II j $ Lt Ir � k UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF-10 YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND W YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ *Denotes potential additional costs above the total estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work, furnish the materials and labor specified above for the total sum of:$ J 3f (*) (Dollars) Payment will be made according to the following work schedule:�2 $ deposit upon signing contract $—.—by_/_/_or upon completion of $ upon completion of contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram or by delivery,not later than midnight of the third business day following the signing of this agreement. See attached notice of cancellation for for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Acceptance of the Contract Proposal Home Owner(s)Signature(s): 1 Date: Contractor's Signature: Date: 1ambertroofinp-ac® (Please see reverse side) Company Insurances TGLRC Inc.DBA Lambert Roofing Company will provide certification of insurances,demonstrating that we are fully insured for worker's compensations, general liability,automobile liability and an umbrella policy.This documentation will be sent through the US mail to the above named party if not already provided. TGLRC Inc dba Lambert Roofing Company agrees to: • Commence the described work on or about ® Complete the described work in approximately days. • Not be held liable for delays due to circumstances beyond our control. • Not be held liable for any damages to landscape and or fixtures due to circumstances beyond our control. • Not be held liable and not covered under the workmanship warranty,for pre-existing conditions including but not limited to: • Mold and or wood rot,defective,faulty,rotted or worn building counterparts such as,but no limited to:siding,roofing,masonry, plumbing and windows,all of which may jeopardize the watertight integrity of the structure. • Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. • This contract is the complete contract unless a signed Change Order has been executed between TGLRC Inc.DBA Lambert Roofing Company and the Homeowner/Business Owner or Agent. Permits A building permit may be required to remove and replace your roof.It is our obligation to secure these permits if required as the home owner's agent.Note: Homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. Accelerated Payment A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Payment Terms A finance charge of 1.5%a month(18%per year)will be added to all invoices on the 311 day.All legal and or collection fees will be paid by the binding holder of this contract. • The law requires that any deposit or down payment required by TGLRC Inc.dba Lambert Roofing Company before work begins may not exceed the greater of- 0 1/3 of the total contract price or: 0 The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule. Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regula 'on and the consumer shall be required to submit to such arbitration as provided in MGL c 1421. Owner: ✓J J a' s �� n Date: Contractor: Date: 1�� Contractor Registration All home improvement contractors and subcontractors must be registered,any inquiries about a contractor or subcontractor relating to a registration should be directed to: Contractor Registration: Director of Home Improvement Contractor Registration Board of Building Regulations and Standards One Ashburton Place,Rm.1301 Boston,MA 02108 (617)727-3200 Home Improvement Contractor Law: Consumer Information Hotline Commonwealth of Massachusetts Office of Consumer Affairs and Business Regulations 10 Park Plaza,Rm.5170 Boston,MA 02116 (617)973-8787 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 Cancellation You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be in the main office or branch thereof,provided you notify the seller in writing at the main office by ordinary mail posted,by telegram sent or by delivery,no later than that midnight of the third business day following the signing of the agreement. INITIALS The Commonwealth of Massachusetts Department ofIndustrialAccidents I Congress Street, Suite 100 Boston,M4 02114-2017 wwwanass.govldla Workers'Compensation Insurance Affidavit:Builders/Contractors/EilQctricialis/Plumbers. TO BE MED WITH THE PERMITTING AUTHORITY. Applicant Information 6Please Print Legib Name (Biisiness/Oi-ganizatioi3/fndividiial): - A. Addres9i ty .— Zp- lie ' Phone : ;Ci / i Are you an employer?Cheek the appir"opriate box: Type of project(Tequired). lam.a employer with employees(fall and/or part-time).* 7. F1 New construction 2.[:]1 am a sole proprietor or partnership and have no employees working for me in 8. F]Remodeling any capacity.[No workers'comp.insurance required.] F1 3.E]I am aborneowner doing all work myself[No workers'comp.insurance required.]1 Demolition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. 1will 10 F]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.FJ Electrical repairs or additions proprietors with no employees. . 12. Plumbing repairs or additions 5.R I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1�4§40of re These sub-contractors bay.e employees p .�s and have Workers'comp.insurance.t airs 6.Q we are a corporation'and its, officers'have exercised their right of'exemption per MGL c. 14. Other 152,§1(4),and we haven employees.oyegs.[No workers'comp,insurance required.] rArry applicant that checks box#1 mast also fill out the section below showing their workers'compensation policy information. fi Homeowners who stbriiif this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. fContractors that check this box mustattachedan additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Jfthe sub-contractors tav'oemploy.ees,ilicy must provide their workers'comp,policy number. 1 am an employer that ispi-ovid6ig worker s'compensation insurance for'my empl6yees.'Below is'the policy and job site information. Insurance Company Name: .\Policy#or Self-ins.Lic.#: Expiration Date: A-Cob Site Address: City/State/Zip: I-J ttach a copy of the workers'c'ompepsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required wider MGL o. 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 fortA 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 thepains andpenaftles of perjury that the information provided qhove is true and correct. i nature: Date: hone Official use only. Do not write in this area,to be completed by city or town official. .=nare- on') 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 AC"R"' IIATE JJM",'DI),,YYYY) CERTIFICA22M 01F LIAMUTY IINSURANCE 03/28/2016 7 F I , T1-!IS CERTIFICATE ISIS SUED AS A NAI AT T 10AND RIGAI`' JPON THE CERTIFICATE HOLDER. T.HIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ,ALTER THE COVERAGE AFFORDED BY THE POLICIES SELOV�'. THIIS CERTIFICATE OF INSURANCE DOES NOT COiNSTI'TUT& A CONTRRA,"T BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holderisan�ADDITIONAL INSURED, the policy(ies) must be --- __en_do,sedll SUBROGATION IS�WAIVED, subject to the terms and conditions of the policy, certain policies nia- certificate holder in lieu of such endorsement(s). require an endorsement. A stater-.1-1 alit or,this certificate does not confer rights to the PRODUCER NA 6SE ! ALLAN INSURANCE AGENCY INC. P V 0'1 E 1976� 745-59()5 FAx I G3 1/2 Jefferson Avenue 2nd Picor e-r-1d; 11 aninsurance-corn P.C. BOX S111 AFFORDING COVERAGE SALEM' rte. 01970-051--. JI LNSUREFA:A_SSOCiaued -rid Ins Co. NAIL tr i.nsiirance- Co. -- TGLRC INSURERC:National Union Fire Ins Co. I cMa: Lasabel:-t Roofing ccs. 265 Winter Street e Am�_�_�c _c a a I"YA�s u-�r Cal-n c e C o. M-RUREPE-Ace American Insurance Co. Haverhill ZA& 01830- IN_sUREF?F COVERAGES CERTI'ICATE NUMBER: ----I I,- REVISION NUMBER: IH IS. TO CERTIFY THAI ME POLICIES OF INSURANCE LISTED BELCA-.1'H'-'�'E BEErj ro 11-1i.- INSURED NAMED ABOVE FOR THE POLICY PERIOD lN1l:CA4FU W_4V-1,THS1AN[)JNG ANY REOUIRETAL1,11 TERI.! '--)R C-,FHER DOCU%IENT VATH RESPECT TO VJ111CH THIS (�ERTIFICATE 'JAY BE ISSUED OR MAY PERTAIN THE INSURANGIF AFFOR[)F!-� 8y TN_ Ir1-IFF DESCPIREI) HEREIN IS SOBJECI TO ALL THE TERMS, L 7 R TYPE OF INSURANCE EFT_1ooLg' Ir POLICY INUMBER, 'ewnmy'YY I LIMITS GEt EiK.L LIAPILITY rf-,t IRRF W1 1 000,000 X l4iival IAPI: 1, --1.1 A,,ii 17_7-1�t ry Tt T 7— 'A' r A Wational Roofero Assoc. P1 14','1NAL.3�'PV 11,111 vy 1,000,000 2,000,000 -A'41 A 2,000,000 : ,OMP*P AGG Z VOLIC, AUTOMOBILE LIABILITY 1 000 000 B INJUR";-L-r 7-1 6:'.038TH x 81_-L)!i', lllj�lily: x x r. Y()A%.A' X f UMBRELLA LIAS x FXCESS LIAR 5,000,000 WORKERS COMPE1,4SATION ViC STAM I 101H �N i,N,Aif�36 2 L '—LAI-1— VF ;T I 1.000,000 D I ,,n�Iry In PIH) [!.A AL-FA EMPI,�'�,Yj ; 1,000,000 O:SEA CE-I-":,11:'e I lt,7;T r Z 1,000,000 E worker,-- compensation ETH ] ,000,000 6 S 6 2',JB-13D8 1 1 N-H 11000,000 t4SCRIPTIO'4 OF()PERAM'6 LOCATIONS VEHICLES IAI!d,;[!ACORD 101,AtJ(w,,,,f CERTIFICATE HOLDER CANCELLATION IHO�JLU-ANY CIF THE A30VE DESCRIBED POLICIES TGLRC dba: Lambert Roofing HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 265 Winter Street ACCORDANCE WITH THE POLICY PROVISIONS. AU`ItiokfzfL� 44, A' Haverhill i�ih 08 3•vj- ACORD 26(2010/05) t,1988-2010 ACORD'CORPORATION. All rights reserved, Tht-A'CORC,naipc,anci jogu,ire FCglsiereu faarks of A(JORD CS-078130 RICHARD J LANMERT 265WINTER ST ET averWH MA 01.034 0602/2014 " �: 'y�/Ff ✓� �4° � r �Nf�Nk i � /,,F!i .N � F � f� ��'�f ',�a Nr� ✓�d�d�f ,�^N f u r��1 Office of Consumer Affairs and Business Regulation 10 Park Plaza d Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration; 149221 Type: Private Corporation Expiration; 12/6/2017 Tr# 273093 T.G.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT — 265 WINTER STREET — HAVERHILL, MA 01830 _.. Update Address and return card.Mark reason for change. W"' u 4 .'-%rA W"'r i U Address F] Renewal ❑ Employment F_j Lost.Card