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HomeMy WebLinkAboutBuilding Permit #455 - 100 ELM STREET 1/11/2008 "oRrH q BUILDING PERMIT o� TOWN OF NORTH ANDOVER �? 4�''` �..6 oL APPLICATION FOR PLAN EXAMINATION (( o P Permit N0: J Date Received �SSACHU`��� Date Issued: ' / (9 IMPORTANT:Applicant must complete all items on this page x L CA,ION PRC3PERTY 01NNEn. R MAP NO PAFZCEL" ON11G DJSTRIT1�stonc Dislrrct fireso 15 r Nlachi h, 11'Adies =no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic, we 5n �, Floodplain Wetlands = " = Watershed District ` �a Vllater/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Ide ification Please Type or Print Clearly) OWNER: Name: Gee- Phone��3` ep�G3J Address: L r CO,NTOTOR rrt Nae t.. . lh Phoneme Supervisor's Construe#ion License e. Exp Date -e2 Horne lmproverner�t License ' ' / 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: $ 3, , 46 _ FEE: $ � Check No.: �7 �` Receipt No.: 02 b l I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature'of Agent/Owner --""" at ire o.-contractor Locationf�U No. Date �'O NORTH TOWN OF NORTH ANDOVER N? • •• G + ; , Certificate of Occupancy $ Building/Frame Permit Fee $ JAGMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #_ 20891 .� \,... Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT Tmp eDumps r o i e yes nn Located,-' 124`Main Street!' z ,jr' Department signature/date COMMENTS 4 " Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 NORTH '9 0 0 � _ over ti.. ;. 0 No. '� �•�/� O o dower, Mass.,-- COCMICMEWICK y�. 5 RATED PPF. ,�5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING .INSPECTOR THIS CERTIFIES THAT........� .ov.1 .........1.!0!&............................... .................................................................. Foundation has permission to erect........................................ buildings on ....14...0............V.4......sT.. T. Rough to be occupied as.............r�j .... G. .........................'�.�.. �..... �... ney provided that the erson acce ti fiis permit shat in every respect conform to the terms of the application on file in Final P P P g 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 EXPIRES IN 6 MONTHS � ELECTRICAL INSPECTOR UNLESS CONSTRU TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place o�n the Premises — Do Not Remove Final No Lathing or D■ 7 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. FAX N0 (blyJJdugO RUG-31-2001 FRI 0851 AM BOYLEC'INS. INSURANCE NO, 6909— K I/1 AUG 30. NO- 6, 08P ASSO �SSU�pA�� 08/30�1UU7 OD LDY THIS C5RTIFICAI'�!S 155 UD ABS CERT1PIChTT;I OLI)p-THIy CFR IIqY 6 PRODUCER CONFERS NO RIOHTs UPON TH D095 NOT AMEND,EXTEND OR AY,'T'BRTUE COVgAAQS AFFORDE oylo insurance Aevnzy POLICW BELOW, C)Box 606 CONVANIES APPOgDING C0VEFAGE obum,MA 01801 SURA COMPANYAA•I•M•Mutual JnvuTancc CQ Q L R C lnc L5TTER ba Lambctt Roofing Co. 63 Wintol S 3avurt1111,MA 01a30 U�ReMENT,TERM OR CONDITION OF ANY c y T' M�T OROTHBX DOCUJ-aNT WITH RESPECT TIFX THAT'fH6 POLIGLSS OF IN3UILANCE L19TED BELOW HnVE BB�1 I99UH&A��POL�4�DaSCRIBED I{M�SUBJECT TH151570 Cly TNSURANCR AFFORD rMOD INDICATED,NOTY/1T TAIIn�O ANY C6RT1F1C�+TEMAY BE 1sS1.16n OR:tilAY pp_ T� 70 WHICH TW S g[pN5 AND NDITIOivS OF SUCH PflUCIP.S•LIMCI'S SHO MAY HAS HBaN�DUCI;DBY P/.TD CL Yt r0LICYIJ(11T.�n0K L1MR� T- ALLVFTB roucY[»t{Tr CAW�clu>x>m1 rO1SCY NV}[l CR DATE(FM�9d'M c0 rY1EOIINSUE,tiNCC �,(vwwAoo�c..7a �n Ga IPI csl(cnu uun rrY /pzoKAt x APY•NAW Q"{A1=AL G ww'kl•L LL rfY TACH :MINCI n a MANf-z'O o tt 4 COMT—Toly HOT. Hit1,Lb-.i'C>: •"'�� cOI.mINiD Yv"c" Ln.i rr AVTpyuOLLJ{.[..L UTY 4DD1r Y"Mv Q a?M=) ANYALW ALL Owl AVID& 11 ,111V NJVLY VWGDVL6D AVrCd (1 K[G104 HRAD 1100 W 1bOJ N RAl1Aw NON400 AVro$ a'L�zs W"rLma q{QCCt�YNCe AfLAD(1wTY t.zCCN LU3LLITY umAmiA ro"x 7m pTl�riT1V•I7 .0 rolls �,TLrTnRY tSMITS OATLON A.NO X WK1t1t�CT,L�IDU. EL EACH A.CCIDSNY 500,00 etaPLOYF.RS cY AL'J� s 600,000 .ucv 6009966012007 Oa/z8/20D7 08/28/2006 flEl EL DIS�9EElOiCH EMIT 500,000 �ayftl. 811PLQYbB COMA DggNIPTION OF OFM"T ONS OR LOCA'i`lONSr OVLD ANY OF THE ABOVE bescs bI D)OLICIPB IV C).Wa,r Ftl BSFGIE TNS tlXPIftATION DA72 OFW NTS 7V INQ cl I`4 T WILL PA1llJAE OVMAlt SUCH NOT(CE 9fAL L A(POf Nqncg E 0 0l UQATIONAT TO"OF WINCRES7'ER R LLlB,UTY OP ANY KIND UPON THS CQWAT7Y,ITS AGENT OR RB713SalTwTNPB, I MOUNTVRNONS7 CHIST�R.R11► 0189V fie �arniaxan,�aP,alth o�./7/LaaaacLesaella Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 149221 One Ashburton Place Rm 1301 Expiration: 12/6/2009 Tr# 262486 Boston,Ma.02108 Type: Private Corporation LAMBERT ROOFING CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL,MA 01830 Administrator Not va► without signature J/MX7rorB1uaiM1ding�ReVlaat�ons an Mand�ards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12/6/2009 Tr# 262486 LAMBERT ROOFING CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Update Address and return card.Mark reason for change. Address Ej Renewal F Employment E] Lost Card DPS-CA1 0 50M-07/07-PC8490 Board 0f Buil . din Re u g CJ Iafions U9 One Ashburton Puce, fpm 1301 Boston, Ma 02108- 1618 License; CONSTRUCTION SUPERVISOR LICENSE Birthdate: 06/02/1972 Number; CS 078130 Expires: 06/02/2008 Restricted To: 00 RICHARD J LAMBERT 95-MAPLE AVE AMINSON, NH 03811 Tr, no: 27100 Keep top for receipt and change of address no(IflcaoQn. pPS G� 0 $QW-0-WYPC /91 01/09/2008 11:47 9786637211 OCONNOR HARDWARE PAGE 03 W,1 0o/08a'20081,u, a I� 36 K9 cehard 1d. Lam e�ri. O0ONN©F] I fd�f�ISWp'RE PAGE 02 6!�'i3s295Oq p 2! i i T_ Cr. I. . R _ f, . INC . , $ji°L / I,A. MBERX 'R00FI .NG CO . Tin bmsl � s.r.r ')DATE- 01-07-2008 � A7 TN, SHARON LEE, (MAILING ADDRESS; 52 W-ALlCER R'0'Ab.,A'1xM0N� NA 038111 xBJECT., NEW SINGIE-+PLY P'odp SY.:31EM A7'10)'Ei:,M 5 FT NCyRT:H .ANDOVER., MA 01845 PHONE; (603) 362-6037 FAX: (978) 663-7211 WE PROPOSE: TO the following Single-ply roof c6nstzuc6on on the b'titding the abovc address as ,per. detWed de8criptxon listed bx:elow. A�p:totoo roof arc.{: 600, +ox-.8F" SINGLE-PLY RdQF- ��' SAT �I!s; F 1) Pre-pare for re-roofing by ex�vxI g all sufl lVvmt� e"3 are takAm ira accordance with OSHA standaids and 1=Uocapi a it pr petly pioiec;ed 2) Rcmove all existing'roofine d�btis !uid s:it xtated Ab:;r board dowo► to good decl_. Inspect wood deck,if we disc6vex acny totted'vvogd replacement twill be performed at $65.00 per (4' x 8) sht;et pjywor., or,83.00 per'&lot for pine boaxds and properly nailed to deck. IT wood is goianci are mill bb r1a Jany loose wcood to rafters, sweep deck and prepate for r6a^,Ewg. TWO SIXTH' FIVE WINTER STREET HA�I.Ii.HIL;L, IxfA,. 01830 (976) 374-9224 (F.A, K;) 521 ..5791 OR '�']A E; MAIL LAMBERTR00FING®A0L'CQY,1 OR VISIT 1133 0N1 TRE WED WWW.LAMD R'":CR:OOPING.tll E3T BIN# 51 -05-33;',13 IJCS# 0751.30 01/09/2008 11:47 9786637211 OCONNOR HARDWARE PAGE 04 bd%bU/2008 12: 36 978663721,1 pCONhJ� HARDWARE PAGE 03 iu: �qa Kichard' J. i_at�ber 10 m"13 629�-i0C1 9 i P' i 2._. )AMARx 7,2008 ►. } Tnetall pre®luxe treated od�tttailea a+au1�rl peri �r, j 4) Mcchari caRy anch�r im, tapevd'1'')p1YI-soCyaziUn* .d,;;:i:d Insixlation 4 slope w &C c�Sib �J existing roof U64i 3"plates :,Cxc.* to fasten. 5) Furnish and insta a nevJ '9A=.d I.,00f cyst, aI 11130$. 60� mean e. All the psol3ee sealanw 'Arx, I/OXI cauWngwill be 14'ormed co eust_7se seconda ry cuntaitLtt�mnt. , i I PedMetet edge w& rece;l a rTRITEE' abnin%ilut><1, drip edge style finalhizag as zeqtmrer#, 7) Re-flash 8.11 il7allS, 6tilex9 Ana Pmaftt-tif)nLS as req�iii.red and }3 Wted by good roof practice to ensure water txghtn►(MIs. i 8) Supply(4-6)walk war mzfh.c pad;' out3ide of windo"Y-s., i !A11 debris generated by the TG.L-R.C.,Inc.vM be deaned l'iti a,id di-J)oscd of from the job site it1,a legal fashion. Un&r no c=it stanc.-e tui]l rhe wa.tftdt �;h integury Of ffic bttWiAg be corxipxgxni.tted. • ii NOTE: We understand this is. not- yau>C average rootvk pxojc�ct. DeJlow fwd out ;pledge to eltnue pre,work in proglfts 191�td pout construe1 ion is a m1fe, comfortable alxd speedy process. 'M wcnkwAnsbip will be performed try the itstnd:,uAs and impe=doiis miforced by the Th :Edition Maegaebuaetm Bwldinlg GoO..; ' L1.nt:pstdcted cirjis.tructl:)n tupervis6r license #UCS 078130 will, be ao mite and/or aCteiis:ibk, d 1gandy Au::lu;,rh ouic the prdjact. We will ;discuss in detail the project a1itig and.f0Jobu-c>ur coiUmmUmot to the best of our ability, I� l� illRUl�tte T.G.L.R.C.INC, Agrees to emo peace dwfibed'o OJ!11 ih the mon. 4X (fan. 00) inti the described wurk will be completed in about (� wnrki19 d+ip�s. T.!:><.l'.,A..C. INC:. shill ries be held liable fu delays due to OTCUMIm pas bayood ow cotiaoL T.G X.,kC,DRC. miv nor Ix h6ld 613lo fox zany duxnage&to landscape, s tncs�rtrd�`arQxCu<e��u�to Craw naruc� cyarnrr�oiu`ctaa'crol:- G3::) It E �knnlls►sE l jig�d liable For nTc-exiatitig cooditiorso inchuliog but not IksxdRl;Gl to mtold rad/oi v;rx d rot. ':Acfe�dv�y faualtq, worn biuildiag cowterparts auth as but nui llrmited to sitting,gumcvr ii-mRonry,plambing,acid w'ksldows that fw�di�,.-the-�Mfesti�t'"intet�i4�-c�f�Ft'�ig i>.te�o�Qom'�uc4ar-thti5"3�'aFiitg"v.,�anry"_"'--tic.._~ tolbwWg work includes all labor, u4ti6al% and disposal ii Id to 4wowplete your yob in st pwcssioaal wadeffiftaAMP]hike XnAi7utef.i i i i 01/09/2008 11: 47 9786637211 OCONNOR1 HARDWARE PAGE 05 _ .91/08/2008 12:36 9786637211 WOW& HARD44RE PAGE 04 K�cMard J l.an��r•rl, . , ��i1.1,�629�D[I I p. 4 . I I JANWY 7„2008 I 1 UPON COMPLETION )kND PA lem- IN FULL a4► 40 VjsAj 'WARRANTY .FIND A 1Q YE iCfi ' 0Rl0tA3tiT'SH' r' ,QVARIi:A'1N'],"°Y WILL BE HONERED AND ISSUEb FOR TkE JnZW 16:00P �''!�I'];'.FI►t. � he cost for A Quits, warrant'p, la": &: rruaterialr is ��;-oom ��'hr+.:e 4'toe d might hmdred dollars), :*Pa meat Tetras: i y /3 d ow*,upon oompkria,a 1payan-entlr,l full. i A.cceptAnce op oposal; I i �S &tlxre at �. I Please.: sign R'd retn= pne copy upon acceptance. NO TEE Dirk to wljWiln,p[ong o.�,lin i,dixw !9nduces,this ptlopoeal is mid,if norwaespted P60do IS04Va of';wcepiian. kS Cdnv -�bn. W f�k gi�- L4A4 ! � � �` ( (01019 LJU� DO ', "Quauty V� rlcm: hip You COD r sort y firs I:, j Ptes star./ uahi 7 Control ' I i I , i i f j I i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLibly Name (Business/Organization/Individual): CQ " Address: City/State/Zip: ' Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 4. I am a general contractor and I I am a employer with ❑ 6. []New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑.Remodel ing ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp, insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Pummig repairs or additions 3.❑ I am a homeowner doing all work hcised. -Plumb p myself. [No workers' comp, right of exemption per.MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we ave no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub=contractors 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: G� J / CitylState/Zip: �j�i>'D /li��U/�'ff'` 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 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the ins and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: �?F,3;;Z_4269 r/ 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 one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: