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Home My WebLink AboutBuilding Permit #819 - 103 OLD VILLAGE LANE 6/6/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Ell Date Received Date Issued: r IMPORTANT:Applicant must complete all items on this page LOCATION A2 0k) il� llaQez l`1 % Print PROPERTY OWNER rAACY01 , Print MAP NO: PARCEL:ZONING DISTRICT: Historic District yes Machine Shop Village yes 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 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ` .f Septic Well ®Floo'dplaui0�Wetl"ands J r f `Wat_rshe�dDistric�� . ®Water/Sefwer , - -A., -,. N DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name:-Al -0 V�x Q-)AIt,u .,e— Phone: Address:t(72 Q Q� q f\\ct!�t e— it CONTRACTOR Name: `,C�,`„a ', Phone: Address:'�L&5 Supervisor's Construction License: C� 9130 Exp. Date: - - 1� Home Improvement License: � �-,� Exp. Date: QK- (p IA\ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ to f k FEE: $ �q Check No.: (-M�2>J Receipt No.: a -�-- NOTE: Persons contracting with unregistered contractors do not have access to th gu my f nd F-.c.t.s• - 1..'. ....i iia . Signature ofAenfilOwnerz-' y., . ,,. ;:e, Signature . 'C' nt'ractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DIS7ETOa, Public Sewer nning/MassageBody Art ❑ Swimming PoolsWell acco 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 I CONSERVATION Reviewed on Signature 1 I COMMENTS HEALTH Reviewed on Siqnature COMMENTS a a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water & Sewer Connection/Signature Date Driveway Permit DPW Town Engineer:Aignature: FIRE DEPARTMENT - Temp Dumpster on site yes LocatedTemp Osgood Street Located at 124 Main Street i Fire Department signature/date COMMENTS i 1 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. 1 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 I NOTES and DATA— For department use it I ® Notified for pickup - Date Doc:.Building Permit Revised 2008 r i 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 ❑ Copy of Contract ❑ 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. Licep- ❑ 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 MOTE: 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 Chat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording rnust be submitted with the building application Doc: Doc.Building permit Revised 2008mi NOV-30-2010 TUE 04:06 PM ALLAN INS AGNCY FAX NO. 978+745+5483 P: 01 �„w CERTIFICATE CF LIABILITY INSURANCE D ; PRODUCER 11//30/30/2001010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ALLAN INSURANCE AGENCY 114C. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AMEND EXTEND OR 63 1/2 Jefferaon Avenue 2nd F ALTER THE CIOVF_RAGECAFFORDED BDOESOY THE POLICIES BELOW. P.O. BQx 511 SALEM MA 01970-0511 COMPANIES AFFORDING COVERAGE -_. -... COMPANY A Seneca Inaurance Company -' INSURED -- TGLRC INC dba Lambert Roofing B Safety insurance Group 285 WINnR STR1;ST COMPANY Landmark Insurance Company sAV'ZMILL MA 01830 G.._._.... COMPANY p National Union 1"`ire Insurance COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWMAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERIA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS Cr ERTIFICATE MAY BE ISSUEDOR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS StiO VN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY-EXPIRATION LTR T DATE.tMM1DDrYY) PA7E(MMIDDIYY) LIMITS _GENERAL LIABILITY BODILY INJURY UCC $ 11OOO,OQO X�wO.MPREHENSIVE FORM SGL3000422 / / / / -- -- bODaYIN•IURYAGe T 2 000,000 PREMISESfGPERATIONS __.............., ....._... PROPERTY OAN.. . A A I UNDERGROUND PROPE__......._.. .CE OCC-., S 2,000,000 EXPLOSION&COLLAPSE HAZARD / / / / PR.CPERTY DAMAGE A.GG $ 2 000,000 X PROD UCT*/C,OMPLETEDOPER }{ CONTRACTUAL 31/12/,2010 11/].2/2011 BI&PD COMBINED CCC, $gl&PD COM91u=U AGG $ INDEPENDENT CONTRACTORS PERSONAL INJURY ACC $ 11000,000 $I BROAD FORM PROPERTY DAMAGE I Medical Payment 5 000 X PERSONAL INJURY - � _A_UTOMOBtLE LIABILITY - ---- _ ANY AUTO SOD11-Y INJURY (Por vorsori) s }3 K�ALL OVINEDAUYOS(Priva:oPass; 6203819 07/16/2010 07/16/2021 BODILY INJURY $ MqLL G,41n, AUTOS (Oilier Ihan Private PaeesnngQr) , X HIRED AUTOS X i NON-OWNED AUTOS / / / / PROPERTY DAMAGE GARAGE LIABILITY BODILY INJURYB I '•• COMBERTY DAMAGE a 1,b00,000 _.. EXCESS LIABILITY -- C Xi UMBRELLA FORM EAC -- H O�CJRRENCE "u 5 OOO,OQO � 054597 11/12/2010 11/12/2011 AGGREGATE 5 000,000 OTHER THAN UINdRELLA FORM - WORKERS COMPENSATION AND . C STATU- S D EMPLOYERS'UA6I LITY 009934145 / / / / ......-..__.... X OTH ........._.. ... .- .. .. . —.TD6Y unri r;;...�-,.. ER THE PRD'RIETORI I X INCL El UCH ACCIDENT $ 1,000,000 ?ARTNERUEXECUTIVE MAr NH 08/28 IL DISEASE�POLICY LIMIT $ 1.DCO,OOO OFFICERS ARE: EXCL. I2QZO OB/28/2011 ELDIREASE-EAEMPIOYEE 1,000,OCO OTHER '... ,.-_ DESCRIPTION OF OPERA'nONSILOCATIONSNEHICLESItPECIAL ITEMS CERTIFICATE HOLDER t SHOULD ANYOF THE ABOVE DESC RI13ED POLICIES RE CANCELLED BEFORE THk EXPIRATION DATE THEROF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS VMTTFN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AN KIND UPON YHE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHOR17 D EPRFS NTATIVE ACORD 26•N{1J8$} � �`�t'L�.r''✓:;': � CORD CORPORATION 9866 r .. O�ce of C; �r us ss Ration PaTk Plaza- Suite 5170Boston, 1 usetts 02 1 E 6 Hon lie=PrOveme'll 1(r RegA atiorA . ReOstration: 13221 e VW PrNaip Cof ro fjoa jFImG co i; 2023 C HI AR-D LAM-BERT se^.�t•_—9 i.+ i 3 �� fikE.,A C31,330 U Address and'etur a Wand.mad re3so j ds f`� �esu��2 (-"1 �srtaraBec,m:^i9� s Board S::`i Buiksfing a RC;�F3Ei:�9?3d'ne; CO'IlstTUC On Supervisoe License License: CS 7813D RICHARDA LAMBFRT 94 PICADILlY RD DIPS a EAS}, NH M411 _xp,,FaVor- W212012 t aa.,taisa:�atrs T T: 30062 10.s TG EIN#51-050-3313amber- Haverhill MA 978.374.9224 MA Reg.HIC#149221 Lawrence MA 978.687.7339 W, MA Lic.UCS#78130 Hampton NH 603.929.9224 fi BBB, Single-Ply License#1711 R199oM Hampstead NH 603.329.8200 Stvu�Z932 p, Toll Free 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 Y Licensed wInsured Factory Trained :Factory Certified Name: l` P`fi ! <.i�y ^_ 1,� _ Date: �Y� �. �•_ t� Telephone: `?Z 1� Alt.Telephone: E-Mail: Billing Address: Job Address: CSC-> ViLr /46=iZ Z&;. Scope of Work ('Strip and Re-roof ❑Re-roof Approximate Roof Area: /repare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected. emove existing layers of shingles down to roof deck and dispose of in a legal fashion from the job site. Inspect wood deck,if we discover any rotted wood, replacement will will performed at*$F per LF for roof deck boards. If substantial deck rot is discovered, re-sheathing of roof deck can be performed at*$ : per SF. If individual sheets are found to be rotted/or de-laminated, removal,disposal and replacement will be performed at*$ Cp per sheet. If any trim boards are rotted, _ replacement will be performed at*$ "�,, per LF for new pre-primed pine. Inspect siding at roof line and all flashing behind siding, if w v 'n r * ' e discover any damaged flashing o siding at the roof line,replacement will be performed at $ a tri . If wood deck,siding,and lashing 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 ti t J-r-, 9,✓Apply ice&water shield (UNDERLAYMENT)as per manufacturers'specifications and/or 21 ea-!v»>N C/$l,t,� � . z s ��`� C: e VAppI premium(UNDERLAYMENT)to the balance of the exposed wood deck. �— lf Re-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness. f�If upon inspection,we discover chimney lead to be worn or deteriorated, placement will be performed at*$ nstall a new: ?x'; Year ❑ Traditional CT Architectural ❑ Designer j' 1ZC<,-AWS. urnish and Install a new shingle over style ridge vent system ❑Soffit vent system *$ lAll 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 watertight integrity of the building be compromised. Special Notes UPON COMPLETION AND PAYMENT IN FULL, ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF Z_ YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND 5'� 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: $6• (Dollars) Payment will be made according to the following work schedule: $ �S 000 .0 G, deposit upon signing contract 6132 Zo'I -a s $ by_/_/_or upon completion of $ �' .Q 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): �( �� "' Date: Contractor's Signature: Date: e.�.n. I�.,�l,,n�+,r�.nn♦Fwrsre nn�xe mi____ __,. .__.....__,. _:a,.. 4 ORTH 0 0 o over 0 .1 No. l' • rO LAKE O over, Mass., L/ - I� COCHICHEWICK 7� ORATED pP�,`�� S BOARD OF HEALTH PERM IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... . ......... �at T........ ..... ........... Gr......................................................... Foundation has permission to erect.................:...................... buildings onla3....... �..V!�1. ...................................... Rough I to be occupied as 632V.. - ....�.�o.�. .—.-' Chimney ........ ....... .... .. . ................................................................................................... provided that the person accepting this permit shall in a ry respect conform to the terms of the application on file in Final 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 UNLESS CONSTRUC N, TARTS ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occlipy Building GAS INSPECTOR 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. SEE REVERSE SODE Smoke Det. LocationU`3 0"/�i�.6G.- No. Id Date MORTM TOWN OF NORTH ANDOVER F - A 9 Certificate of Occupancy $ �ssC s t'�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24zi `�, Building Inspector