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Home My WebLink AboutBuilding Permit # 5/4/2016 BUILDING PERMIT 01 %AORTH TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION # Permit No#: LW Date Received A ED S US Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION (c �n <�k pnt PROPERTY OWNER CS Print 100 Year Structure yes " MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building Nr6ne family El Addition El Two or more family 11 Industrial h'Alteration No. of units: El Commercial F-1 Repair, replacement El Assessory Bldg El Others: El Demolition Ll Other Wet a6 .. ❑..... t4eshoj!Di'siri Wafer/Sewer "sr PESCRIPTION OF WORK TO BE PERFORMED: curA twb-m 2)hkag-( � fra, oarr a,rd J OQ \-atu A aar- ack-til'bn Isle tifieltion- Please Type or Print Clearly OWNER: Name: Phone: Address: Lo 2 �n�� Contractor araePhone. Email: Address: Supervisor's Construction License: Exp. Date:. Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: Check Na.: Receipt No.: `5 2-- NOTE: Persons contracting with unregistered contractors do not have access t ,, "' �' tyfund i t%'RTH own ofE nctover No. - : A! h ver, Mass, o KF 1. CO[MICMF WIC'( � 4ATED P,V U BOARD OF HEALTH ME— Food/Kitchen Pr. Rm T LU Septic System THIS CERTIFIES THAT .................... ... .... ... .... 1...... . . ..................... .............................. BUILDING INSPECTOR Foundation has permission to erect.........4.......... ..... buildings on .... .. .......El............ ..l�O. ..............::. Rough to be occupied as ....... ..... ...... ... .. ...... ............... .............. 11�;........ ... d.....IL Chimney provided that the person accepti g this permit shall in every respect colnform to the terms of the app cation Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Altera Construction of Buildings in the Town of North Andover. rte ® PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT II ONTHS ELECTRICAL INSPECTOR LE 10 A Rough Service T ..... .. Final UILDIN, SPECT R GAS INSPECTOR ccupancp 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. [IN 1151-0503313 '- Haverhill K4A978-]74-9224 MA Reg, H|C1114823I Lawrence MA 978-687-7339 K4ALic UCS 08130 Hampton NH 603-929-9224 �� ~�~�� - Hampstead NH6O]'329'#2O0 -,& _ ^ Toll Free 1-888-SOS-ROOF wwwA AMD s^rnoo~/wo.V°w Z65VVin�erS�reetHavcrh\}} K4A0183O Name: I Dave Hirst Date: 14/26/2016 Telephone: 617-775-8070 Cell Phone: Click here to enter text. Email: dhirst@gtnail.com Billing Address: 56 Elm St City: N.Andover State: MA Job Address: 56 Elm St City: N.Andover State: MA Scope of ,vv/v ISISthpand Re-Roof []Re-Roof Approximate Roof Area: ZPrepare for re-roofing by ensuring all safety measures in accordance with OSHA regulations and landscape is properly protected. ORemove existing layers of shingles down to roof deck and dispose of in a legal fashion from the job site, MInspect wood deck, if we discover any rotted wood,replacement will be performed at*$3.95 per LF for roof deck boards, |/substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$1.25 per SF. If individual sheets are found to be rotted/or do-laminated, removal, disposal and replacement will be performed at*$65.00 per sheet, If any trim boards are rotted,replacement will be performed at *$12.00 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 ^$12.00. If wood deck,siding and flashing is sound,we will re-nail any loose wood to rafters, sweep deck, and prepare for roofing, @D|nstaU8"drip edge tuall rakes and eaves,Color: . MApply ice&water shield(UNDERLAYMENT) as per manufacturer's specifications and/or � OQApp|ypromium(UNOERLAYmENT)iothe balance mfthe exposed wood deck. � lZKe-flashaU plumbing stack pipes, and any roof penetrations as required and dictated by good roof practice to ensure water tightness. � Olf upon inspection,we discover chimney lead to be worn or deteriorated, replacement will be performed at*$450/ea 0O|nstaU a new:Year F-13 Tab DDAohiiectua| []Designer Color: � � XFurnish and install anew shingle over style ridge system Soffit vent 4ac*m*$nla MAII debris generated by Larnbert Roofing Co.will be cleaned up and disposed of from the job site in a legal fashion. Under no circumstances � will the watertight integrity ofthe building becompromised, � Special Nmes6'o(ice and water»hieWcnbeinsta|ledtoenhrebui|ding. Synthetic papetmbeinstalled above ice and water shield. 40 yr � architectural shingles. Ridge vent all applicable areas. Front porch tobecompleted along with driveway side/frear addition. � UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP WARRANTY GUARANTEE FOR PERIOD OF 10 YEARS � HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND LIMITED LIFETIME YEARS HONORED AND ISSUED BYTHE SHINGLE MANUFACTURER MANUFACTURER'S UPGRADE *$N/A � *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;$2,400.00 � Two Thousand, Four Hundred (Dollars) � yoymentwill bpmode according tothe following work schedule $ 800.00 deposit upon signing contract $ by orupon completion o/ $Ro/uoceupon completion o/completion. (Law forbids demanding full payment until contract is completed to both party's satisfaction) You may l 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 clay followini;the�igmnr,of this agreeinent,See attached notice of cancellation for an oxplanation of this right 0ONOT SIGN THIS CONTRACT|FTHERE ARE ANY BLANK SPACES the Contract Proposal Home Ovvocr(s)Signature Date: L- | Contractor's Signature: Date: (Please see reverse side) The Commonwealth Department of IndlustrittlAccidlents C1 ff ice o f`Investigations I Congress Street, .Suite 100 Boston, MA 02114-20/7 Workers' Compensation Insurance Affidavit: Builders/Contractor-s/Electricians/Plumbers Applicant Information Please Print LK�ibl N,gme (Bt,siness/Orgamizatiort/Itidividtial): 1 Address: ( f City/State/ZiA- Phone ff: Are you an employer? Check the appropriate kaon; type of project(required): 1 am a employer with 4. E] I atn a general contractor and I s 6. ® New constrttetion employees (full and/or park-ttta�e).* have hired the sub-contractors 2.❑ I atn a sole proprietor or partner_ listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition. [No workers' comp. insurance comp. insurance." 5. We arc a corporation and its 10.0 Electrical repairs or additions required.] ❑ I 3.❑ I am a homeowner doing all work officers have exercised their 11.0 .Plumbing repairs or additions myself. [No workers' camp. right o't'exemption per MCYL 12.❑ Roofrepairs insurance required.] .i_ c. 152, §1(4), and we have no employees. [No workers' 131-1 Other comp, insurance required.] *Any applicant that checks box RI must also fill out the section below showing their workers'compensation policy information. C Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached all additional sheet showing the name oI'tlre sub-contractors and state whether or not those entities have employees. Il"the sub-contractors have employees, they must provide their workers'comb[.policy number. I duo au eutployer that is providing worlcers'coiiapeit,sation irasterdaree for nay eutployees. Beloit,is the policy orad jolt site information. Insurance Company Name: Q_,, Policy#or Self=ins. Lia #:L,) U j?1Expiration Date: c3c" , � C Job Site Address: (10 �(Y1 City/State/Zil): ' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to 51,500.00 and/tear[,ane-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine Of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of tlic DIA for insurance coverage verification. I do h rcfih ccrti y tlz f r Ing ri d perz t � peijury that the inforXrtatiorx provided itboi,is ti°rce arad correct. under StenEatuac,. "a� Date' (10 Phone##: Of use only. Do not write in this area,, to he completed lay city or town official City or Town; Permit/1,icense # 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#; 4i CE rDATE(MMlDDfYYYY} CERTIFICATE OF LIABILITY INSURAN 1 03/28/2016 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 Jerrold Kameras _NAME: ALLAN INSURANCE AGENCY INC. PHONEf1i (978) 745-5905 Fax NOT: (978) 745-5483 63 1/2 Jefferson Avenue 2nd Floor EMAIL Jerrold@allaninsurance.com P.O. BOX 511 _ INSURERS)AFFORDING COVERAGE NAIC# SALEM MA 01970-0511 INSURER A:Associated Ind Ins Co. INSURED INSURER B:Safety Insurance Co. TGLRC INSURERC:National Union Fire Ins Co. dl-- - Lambert Roofing Co. INSURERn;Ac7e American Insurance Co. 265 Winter Street JINSUREREice American Insurance CO. [,-- Haverhill MA 01830- 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. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 10ATH 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 SHONJN MAY HAVE BEEN REDUCED BY PAID CLAIMS ODL SUBR – ---_v..— POLICY Err POLICY EXP irlSrt TYPE OF INSURANCE POLICY NUP.M1REft MRi1DDlYYYY MMlDDfYYYY LIMITS 1.'rR GENERAL LIABILITY y / / / LA(H OCCURRENCE- S 1,000,000 DAMAI ET 1U NTLD 50,000 �X i r Ot.MLRC tAL GE NERAL_I_IAE311 ITV / / / / PRE MISF S i,Lu�crurr nce _ A fflh� I � (,[MMSMADL Lil OCCUR ES1028029 02. 11/12/201511/12/2016 MIIDEXP(Any ovepe(son) 1,000 ` f lational Roofers Assoc. / / / / PERSONAL e.ADVINJU13Y 5 1, 000,000_per p�ect A99 1� - G1 NFRAL AGGREGATE 2,000,000 Gk:N1 AGGREGATE LIMIT APPLIES Pi R / / / / PRODUCTS-COMP/OPAGG S 2,000,000 POLICY PRO- -- Lor AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT , -LE—Jgs ent} 1,000,000 f t:Y AUTO BODILY INJURY{T r parson) S S ALL OVWi GD X SCIil-Dtki D 6203619 07/16/2015 07/16/2016 AUTOS AUTOS BODILY INJURY(E c acc�donl) S NO OIAINl]D / / / / 'PROPPLRIY IL S w acn don _ X I IiurtsOnuTos X nu1E15 $ � X UMBRELLA LIAB X OCCUR II / / / / EACH OCCURRENCE 5,000,000 C DEEXCESS LIAB C1 AIM �BE018335635 11/12/201511/12/2016 AGGREGATES 5, 000,L000 I _ i — D RETENTION;. V40RKERS COMPENSATION / f / / X 4'JC STATIJ- OHL AND EMPLOYERS'LIABILITY YIN 03/25/2016 03/25/203.7 lI{_ E Tr1RlPARTE ERIEXECU TIVE 6S62UB-:.E09B75-2-16 MA PL CESRt}RE_PROPRIMBE:R EXul JP-D'> N NIA E L EACH ACCIDENT 5 1 000,000 i v D (Mandatory in NH) / / / / E I DISEASE _FA FMPI OYI1 11 000,000 it yes under DE SCRIPT'ON OF OPERAI"IOEJS belox, E L DISEASE-POLICY LIMIT 5 11 000,000 E Worker's Compensation NH / / / / sas 11000,000 6Sfi217A-HDH1311-16-15 NH 112/22i2015112/22/2016 I;o,i�,y,a�ve 1,000,000 I DE.SCRIP TION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) '.. CERTIFICATE HOLDER CANCELLATION TGLRC dba: Lambert Roofing SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 265 Winter Street AUTHORIZ D'REPE2ESENTATIVE MA 01830- Haverhill °r`- �= ACORD 25(2010/05) // @ 1988-2010 ACORD CORPORATION. All rights reserved. (NS025 W'11,,r;o1 The ACORD name and logo are registered marks of ACORD C -076130 RICIURD 3 LANWERT 2.65 WMER STFiKET Hffverhiill MA 01930 06102/2016 Office of Consumer affairs and Business regulation 10 Parr. Plaza A Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12!612017 TO 273083 T.G.L.R.0 dba Lembert Roofing Company — RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01630 _ Update Address and return card.Mark reason for change. U Address f_] Renewal Employment (� Lost Card