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Home My WebLink AboutBuilding Permit #634 - 111 BEAR HILL ROAD 5/20/2009 N BUILDING PERMIT Of �a oT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION * ,� 00 0 ` �7 Date Receive �'�°A Permit NO: d � AT°Dss�c►+us�� Date Issued: o IMPORTANT Applicant must complete all items on this page f 70r i � 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 4il. 77 r� r DESCRIPTION OF WORK TO BE PREFORMED: Ar z2s Identification Please Type or Print Clearly) OWNER: Name: Phone: Address i'g ,-.f *' .: ` a f'�4 f',x w� Ux a '.wt a ✓r-.� y�+�� ;� �� -'� '� .`:. !may- '�'�+ 9 - .. ;.. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 70 FEE: $ i`—y,-1 2Check No.. Receipt No.: �2 NOTE: Persons contracting with unregistered contractors do not have access to the gu an d � naficare of Agnwre� Signafiur�of cr�tractar` — r Location No. Date MORT1y TOWN OF NORTH ANDOVER 3?O�t1`•o •,MOL a • + ; , Certificate of Occupancy $ cNus`� Building/Frame Permit Fee $ Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # / � 220 %., Building Inspector F 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 El- Private 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 ❑ ❑ i COMMENTS i r DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water$ Sewer Con nection/si nature& Date Driveway Permit Located at 384 Osgood Street TV '11i I 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 2 1 A—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 ❑ 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 PPlication ❑ 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 Te ComhMassachusetts � �onwealth of. Department of Industrial Accidents 4 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 Lellibly Name (Business/Organization/Individual): (.� G' fir`` Zee Address: City/State/Zip: Phone.#: Are. ou an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1. 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. ❑.Remodeling ship and•have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑ Building! addition [No workers' comp. insurance comp. insurance.$ required.] 1 • 5. E] We are a corporation,and its 10.0 Electrical repairs or additions offii ers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g 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#I 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. �2 Expiration Date:Epi —ej J Job Site Address: j �� i� City/State/Zip:/ �l .c- Imo. s Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiation 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 under t a sand penalties of perjury that the information provided above is true and correct. Simature: Date: --l/ Phone#: 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#: ORT#q o Of Andover . No. 0 :�: _ dover, Mass., S-01& P9 0 �- LAKE C CHICHE AERATED PPS\ C7 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • / BUILDING INSPECTOR THIS CERTIFIES THAT ...... .."..,............. .......4-1.ftw......................... ..................................... .... ...... .... ......... ............ Foundation or has permission to erect................................. buildings on ///....... . . ......kell....... ............ Rough to be occupied as..... ....... /Y... ....................................................................... Chimney nform i�ih, provided that the person acobpting this permit shall ery respet nform 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 ELECTRICAL INSPECTOR UNLESS CONSTR STARTS TARTS � zw Rough ............ ............... .................................................7.... Service iUILDNG INSPECTOR Final Occupancy Permit Required to Occupy 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 SIDE Smoke Det. la - BoaTro Building Regulat oris an tandards One Ashburton Place _ k oom 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12/6/2009 Trt# 262486 LAMBERT ROOFING CO RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 11 Update Address and return card. Mark reason for char I -1 Address ! Renewal Employment ', Lost ,)PS-CA1 iS 7,OM-07/07-PC8490 -. �I;u�uChu�ctL 1111k.111 -.11 Publiik Board of Buildinu FRc nul,t(iln1N mid Standard-' Construction Super.,isor License License: CS 78130 Restricted to: 00 I i . RICHARD J LAMBERT 95 MAPLE AVE ATKINSON. NH 03811 Expiration: 6Y722010 i ( Ilwul.•l, n r Tr= 262 I - I j I i I I I I 1 I I I I j I I 1 I 8 / 25 / 2008 3 : 07 : 46 PM I 8740 02 / 02 t� S 1 r tt 'IIti i.QY'}s '7 1.I1-:L I ATF,f.; V8 2S 2( THIS CERTIFICATE IS ISSUED AS A I\4AT'T'rR OF TNF(--IRMA'I'IiiN ONLY '.111ru) Irl.;uranrc Agency Inc CONFERS Nq RIGHTS UPON THE CERTTFIC'ATE HOLDER.THIS C'L-RTIPk p(') p)(,. 51 I DOES NOT AMENDEXTEM)OR ALTER THE CC)\/EP•a(31:'AFFORDED R` POLICIES BE OW. - iS L1em.MA 0 1970 I ' COMPANIES AFFORDTIG COVERAGP -- j ITNSURLD ,rrGLRCInc idbo Lianbcrr Roofing Co. COMPANY A-A.I.M. Mutual Insurance Co i)6i wutier Street LETTER i lHilverh)IL MA 01830 t;"ir^;3z„Yr.<4' t - ♦i '., r ♦ .,'l Ii\t. ti iif`.'�' ”{.v�itl� THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISPED BELOW H VE BEEN ISSUED TO'THE INSURED NAMED ABOVE FOR PERF)D INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR ONDITION OF ANY CONTRACT'OR OTHER DOCUMENT W 1 I TCI WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INS RANCE AFFORDED BY THE POLICIES DESCRIREF)HERJ it fi) ALLTHE'PERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM r— --— — - __...._... ---------.............. Tl'P}-OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION IIx DATE(M M/DUKY) DATE(M MIUUl1 ") I.Int IT% ' -,EIIF.F:AL A-'.. CENER4L LIABILITYI i Fc:"�4.TE � IT—__�•�:�' EF:�:IAL�:CNEr AL LIAP•I LiT�i - � "---'--'��------ raM � i :1 i!:` IFIJ�IF;•,� ' I�"J�.av rl Eh;S S CC 4aTRA.CTr4;S PROT FIRE DA.r-0A.WJE LA�iv rn�c I�r••'• ��_�.___.__—_ � MED E?'Pf.NL F.(ArryO M1r,pprs nr�). . AOTOMOBILE LIABILITY LIMIT AN','A!1Ti l.L.:�WNEDAUTCIS GOUIL4'II•IJI1R''I i (Ppr 1?Crsnri) I I $-:HEDVLEU AUTO£ HIRED AUTOS —_— I I II 1 �:VNED A!ITr:-S PODILY IN)I!RY I IGARA.OE LIAPILITI, (Per xndrnU I __ I PPo:�FERT`.DP,(AAGF i r,CESS LIA8f LIT\' __— - EACH i i,;;r!iRRF.NCE IL7—. ,uhaPRELLA FORM — --- _ j Ar:,iREGATE 6� j ,THER THAN UMBRELLA FORM •�"'''+'~:•�'',\\+\1i\+.4'iZ`� � adv s: ,�- .x�j?;Ffw��ir•gsi4ar;�:v.;vl`��1 INVORKERS CONA?ENSATION AND TATUTOR-Y LIMITS 'PREP. ERIPLOYERS LIABILITY X I II (iHF.Pk�if•RIETiIPJ i EL EACH ACCIDLNT PATiN ER$\E:t EJ UTNE , rr I EqI ARE 6009966012008 08/28/20I)8 08/28/2009 EL DISEASE-POI-ICY LIMIT IId I:L L�E.I'CL EL DISEASE--EACFI Y I (II�1 EMPLOYEE COMM ENTS/DESCRIPTION OF OPERATIONS OR LOCATIONS: WORI<I:ILS* COMPENSATION COVERAGE APPLIES TO`MASSACHUSETTS 'MPLOYEES ONLY I I ' I I i i I I I I 'I I -'- ..- <....- _ '��, *"�• 101;: \1��\\�i,+;1';�s;,,iiy �•., - ...--.. .� .. ., --� f�:i.`)'Y'- I :� 'o' :t its) S t'�:11iti,.t:,1.J i HOMM ANY O THE ABOVE DESCRIBED^POLICIES BE CANCELLED BEFOU TFIE ENP I/\ HIM2EOF,TIM IS SITING COMPANY WILL ENDEAVOR TO MAIL Il)WI.ITTEN NOTICE TC OLDER NAME1 TO THE LEFT,BLIT FAILITRE TO NAIL SUCH NOTICE SH,LLL fmPOSE I R L1ABILrrY O;'ANY KDQD UPON THE COMPANY.1-1'S AGENTS OI:RL:PRESENTA IIVE: /r 1 LrrHORIZED I§EPRESENTATTVE — -- I II � 41791 Y78 z3o 167`g7 T. `U�S(ECw YAsf'`yG Ein#51-05033313 mbe BBB MA Reg. Hic#149221 MA Lic. #UCS 078130oofing MEMBER Single-ply Lic. #1711 265 Winter Street,Haverhill,MA 01830 We are: ✓Licensed ✓ Insured ✓ Factory Trained ✓ Factory Certified Installers Estimate for:V-111rkr E- A PLA KE Lip>y Date: V 2 IY74y Z W 9 Telephone 1: +2cs—YS77�7 E-Mail/Alt: ,q Billing Address: )it aE;AiL 14tt-i i2.5 City/Town: /i N ttlflOV A State: Zip: Job location: SAr►7r City/Town: State: Zip: L.R.C. agrees to commence described work on]or about 1--3 wK& and described work will be completed in about 1-7,-- working days. L.R.C.shall not be held liablefor-delays due to circumstances beyond our control.L.R.C.shall,not be liable for any damage to,landscape,attics,interior walls or ceilings;•and/or fixtures-dueto.circumstances beyond our control. L.R.C.can not and will not be held liable for any damage to the surface that the disposal container is placed on.L.R.C.shall not>be,hold liable for ice dam development or damage caused by ice dams. L.R.C.shall not be held liable for pre-existing conditions including but not'limited:to moldand/or wood rot,defective,faulty,rotted or worn'building counterparts such as but not limited to siding,gutters;masonry,plumbing,ondwindows:that(eopordize the watertight integrity of the building:and are not;covered:under roofing warranty. The following-workincludes all perms ,Juibor:and':materiak needed towmplete-your,lab;in;a:professiionatworkmanship h6 monneL .Steep slope Quick-quote::proposal to furnish and l' Ho SF �v instalthe following: Approximate roof area o , 'F . ; Ft ict c 7 ®eeNew Roof ❑ Re-roof ❑ Gutter ❑ Repair ❑ Ventilation e repare for re-roofing by ensuring all safety measures are taken in accordance to 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 job site.Inspect wood deck,if we discover any rotted wood, replacement will be performed at$ ' *per LF for roof deck boards.If substantial deck rot is discovered, re-sheathing of roof deck can be performed at Ste—*per SF.If individual sheets are found to be rotted and/or delaminated,removal,disposal and replacement will be performed at.$ *per sheet.If any trim boards are rotted,replacement will be performed at$V-5 *per LF for new pre-primed pine. Inspectsiding at roof line and all flashing behind siding,if we discover any damaged flashing or siding at the roofline,replacement will be Zrformed at ?5�3.�* H 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. ❑ Install Hug edge(Re-roofs only)to all rakes an eaves. Color Flow xu W"Apply ice&water shield-(UNDERLAYMENT)as per manufacturers'specifications and/or Z <OurtSE r Ue &/Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck. 19'Reflash oll: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 deteriorated,replacement will be performed at ❑ Install a new -'Y10 Year ❑ Traditional architectural style shingle roof system ❑Designer Color-Mkt 4'wc�c�n Manf. 16N'- dFurnish and Install a new shingle over style ridge vent system. ❑ Soffit vent system $ Vd 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 watertight integrity of the building be compromised. Special Notes: I—EAJF. i:_�)(X.Se''"rasG, VEev-rk,_n—AE r, Lv2, k 16✓1�6 Warranty options: k"'Standard LRC ❑ Manufacturers Upgrade $ UPON COMPLETION AND.PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF 16 YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY,AND s_1zAZ YEARS.HONORED,AND ISSUED BY THE SHINGLE MANUFACTURER. This document can serve as a contract,however if a more elaborate contract is desired we will issue H at the owners request. Please sign and return one copy upon acceptance. NOTE-if this contrail is not accepted in—days,it maybe withdrawn by LRC. *Denotes potential additional costs above the total estimated price. Financing is available A finance charge of 15%per month(18%per year)will be charged on past due accounts over 30 days. .s Total Estimate Price: SDate of Acceptance Payment to he made as follows:/3 DMIS i i FALAA&4: (Home/Business owner) Signature (LRC) t L# Signature Haverhill MA 978.374.9224• Lawrence MA 978.687.7339. Hampstead NH 603.329.8200• 1.888.SOS.ROOF(767.7663)• Fax:978.521.5791 "Our Proof is on Your Roof" www.lumbettroofing.com