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HomeMy WebLinkAboutBuilding Permit #633-12 - 115 MOODY STREET 3/5/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: t 2, Date Received Date Issued: f 2� IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER LG G G4/ ,O/oUnit# Print MAP NO:�_o PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no 100 year-old structure 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 ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i �rSeptic 0,Well' O Floodplain ®Wetlands 0 Wat�rshed�Distnct � Water/Sewer _ M DESCRIPTION OF WORK TO BE PERFORMED: (Identification ase Type or Print Clearly) OWNER: Name: t S"InGG Phone: Address: CONTRACTOR Name: Phone: Address: C-)4f Gyi/lI�'� Supervisor's Construction License: ®l�"'/3� Exp. Date: 4 ' lam' Home Improvement License: c7( Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 9 5 FEE: $ // Check No. f 4(1 ��' �: 'a�0 tQ Receipt N :� _, _ ���� moi..\, NOTE: Persons contracting with unregisiered contractors do no/ ve access to the guaranty fund J Signature of�AgenUOwner Signature of contractor, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunmmg 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 CONSERVATION Reviewed on Signature C06AMENTS HEALTH Reviewed on Signature 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 i DPW Town Engineer: Signature: orated. 384..Osqood Street FIRE DEPARTMENT -Tem Dum ster � ite yes no p _ Located at 124 Main Street Fire Department signature/date COMMENTS i L 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.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi J 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. 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: Doc.Building Permit Revised 2008mi Location No. Date ' TOWN OF NORTH ANDOVER e t . a Certificate of Occupancy $ Building/Frame Permit Fee $w Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# 25067 Building Inspector T_ EIN#51-050-3313 'OUR PROOF Haverbill,MA 978.374.9224 is ON ambert MA Reg.HIC# 149221 YOUR ROOF' Lawrence MA 978.687.7339 MA Lic.UCS#78130 •' Hampton NH 603.929.9224 BBB. Single-Ply License# 1711 Roofing Hampstead NH 603.329.8200 •• Siwce 1932 C 0Toll Free 1.88E265Winter Street Haverhill MA 01830 *Licensed *Insured *Factory Trained *Factory Certified Name: MRA MRS Thompson Date: 02—28—12 Telephone: 978 685 5526 Alt. Telephone: E-Mail: N/A Billing Address: 115 Moody St, North Andover Ma. Job Address: Same Scope of Work ❑ Strip and Re-roof entire house. ❑ 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 job site. ❑ Inspect wood deck, if we discover any rotted wood,replacement will be performed at$3.50 per ft for boards. $ 50 per sheet of ply wood. Chimney flashing$375.00 i ❑ Install 8" drip edge to all rakes and eaves. Color White. ❑ Apply ice& water shield(UNDERLAYMENT) as per manufacturers' specifications 6'and up all roofs to walls. ❑ 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. ❑ Install a new: Certainteed Landmark Limited Lifetime Architectural shingle. ❑ Furnish and Install a new shingle over style ridge vent system or equal. ❑ 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. *Denotes potential additional costs above the total job cost. UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF 2 YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND A LIMITED LIFETIME HONORED AND ISSUED BY THE SHINGLE MANUFACTURER (SEE WARRANTY TERMS AND CONDITIONS AT WWW CER TAINTEED.COM). TOTAL JOB COST...Nine Thousand Five Hundred Dollars $9,500.00 TOTAL CONTRACT PRICE AND PAYMENT SCI4EDULE Payment will be made according to the following work schedule: $3,000.00 Deposit with signed contract. $ 6,500.00 Due upon completion of roof. itAORTH Town of 0 dover, Mass., � • � L �. COC NIC HE WICK � DRATED Cl) BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System moRl BUILDING INSPECTOR THIS CERTIFIES THAT..................... ... ......... ...................................................... Foundation has permission to erect........................................ buildings on .....�.,.�� �........�Vlo ..........�' " .............. Rough to be occupied as................ . . . ............ ............... ............. . .. •. Chimney T� •+�• .............................................. y provided that the person accepting t permit shall in every respect conform he 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 MONTH - ELECTRICAL INSPECTOR UNLESS CONSTRUC ST S Rough ........... ..... .................................................................................. Service BUILDING 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. (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 an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Acceptance of the Contract Proposal Owner(s) Signature(s): Date: 3 12— !" M y .f'1 Contractor's Signature: f �y � , - ---� Date: b / / �t�-- www.lambertroofing.com 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 03-2012 • Complete the described work in approximately 1-2 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 31St 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- 1/3 of the total contract price or: 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 Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. Owner: l �,L,� <11 ' Date: Contractor: ' . Date: Contractor Regic ra inn 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, calla 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, . EDATE{MMfQD1YY } 1E CERTIFICATE OF LIABILITY AV L Y INSWRANO /0THIS CERTIFICATE IM11/2 OF INFORMATION ONLY AND CONFERS NO RIGHTS I PON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THt: CVVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,ANRTHE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the farms and conditions of the Policy,certain i3plfCles may require an endorsement, A statemQnt on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER - - -. CONTACT Jerrold Kamerpas NAN7E: _ ALLAN INSURANCEAGRNc�r INC. PHONE (97f3) 745-50 —__ 63 1/2 Jefferson Avenue 2nd Floor E-MAIL FAX Not:(4?8) 745.5483 P.O. BOX 511 .Jerrold@allaninsurance.cam 5A LF—M INSURE.R.S AFFORQtNG COVERAGE NA3C A MA 0 1 9 7 0-0 511 __._..__-.._ INSURCRA;Seneca 3 ecialt ;Rs. INsuREQ '�"'• TGLRC Inc, INSURER B:Safety Insurance Co an - M _ INsuRERc:Alterra Excess & S 1us Ins 265 Winter Street . dba Lambert Roofing Company NSURExD:Chartis Insurance Company INSURER E Haverhill MA 01830- ..INSURER F.. . COVERAGES CERTIFICATE NUMBER; REVISION Ni1IVIBERs THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE. POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT 012 fTfFIER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TIfE INSURANCE AFFORDED BY THE CONTRACT POLICIES R OTHER DESCRIBED CU HEREIN IS WITH RESECT EC ALL THE TERMS, EXCLUSIONS.AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEid REpllOF_D BY PAID CLAIMS, INSR LTRtGENERAL YPE OF iN541RANCE POUCYEYFF OLICY EXP' ----- Pout*NUMBER LIMITS BILITY .YYYI EACHOCCURREticE: 10000( clA;.GENErtAL LIA8iL3TY / J / J DA E. - -- PREMIS Ea o cutrene S 5000 A ,'wIS•FA.AO OT-CUR, J-CGL0000000696-0'1 1J12/201111J12J2012 + MED EXP iAn onn norson) � l Ot: PERSONAL A ADV INJURY 5 100 0 0 6 GENERAL AGGREGATE 200001 I GEN'L AGGRC-GATL LIMIT APPLIES PER: ! ! ! J POLICY PRO- LOC PRODUCTS COMPIOPAGG � 20000( I ! I ! / S AUTOMOBILE LIASkLITY COMBINER SINGLE k.WIT Ea accident) 10 0 0 O C $ ANY AUT^ / / / ! BODILY INJURY(Per po,$on) S X ALLOA'NFD X SCHEDULED 6203819 07116/2011 7/16/2012 AUTOS AUTOS BODILY INJURY(t>nr s dens} S X HIKED AUTOS X NON-OVMED AUTOS ! ! / ! PROPERTY DAMAGE 3 Per accirlerstt UMBRELLA LIAR x l OCCUR ! ! ! I EACH OCCURRENCE S 500000 C X EXCESSLIA6 CIAdNfS-ivlA{5E 18050000040 31/12/201111/12/2012 AGGREGATE CED RE1ENTiON SWORK RS TION ANDE PLOYE:PELIAILIT YIN _�....! I / VV(:SIAT'U- �. O'r11 AND EMPLOYERS'LIABILITY AIN' PROPRIETOWPARTNER/EXECUTIVE , NIA E.L.EACH ACCIDENT 100000 D O�FIC£RJnAEMSER EXCLt.IC.�EO^ � c (Mandatory In NH) 0001-60-2396 08/28/201108/28/2012 E.L.DISEASE-EA EMPLOYE c 100 00 c rESCRI scribe under I / I / D,=SCRIPT,ON OF OPERATIONS be`:ow E.L.DISEASE -POLICY L:MIT S 100001 3 DESCRIPTION OF OPERATIONS!LOCA-n0N8/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2010105) O 1988.20101 ACORD CORPORATION. All rights reserve INS025(�,atoos)tis The ACORD name and logo are registered marks of ACORD Boar"L! 11 �ZK-1 CS 78130 RICHARD J LAMBERT 94 PICADILLY RD HAMPSTEAD, NH 03841 6/2/2012 30062 J. Office Of Consumer Affairs and U 7L eu s 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12/6/2013 TO 218746 T.G.L-R.0 dba Lambert Roofing Ccm RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 T. update Address and return card.Mark reason for change. F L:] Renewal DEmployment Address Lost Card The Commonwealth ofMassaehusetts Department oflndustria[Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 'Y www.ma_ssgov/ciia Applicant ntformation Workers'Compensation Insurance Affidavit:Builders/Contractors/L+lectricians/Plumbers _ I Please Pruit Le�bly Name(Business/Organization/fndividual):_ LC�/, eg Address:-City/State/Zip-AWPhone#: F n employer?Check the appropriate box: _ a employer with, 4. Type of project(required): ❑I am a general contractor and I loyees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction a sole proprietor or partner listed on the attached sheet.1 7. ❑Remodeling and have no employees These sub-contractors have 8. ❑Demolition ing for me in any capacity. workers'comp.insurance. orkers'comp.insurance 5. ❑ We are a corporation and its 9• ❑Building additioned.] officers hake exercised their 10.❑Electrical repairs or additionsa homeowner doing all work right of exemptionper1VIGL 11.❑Plumbing repairs or o dditionsf.[No workers'comp. c.152, §1(4),and wehavenoin required.]r em to ees. 12.[]Roofrepairs p y [No workers' comp,insurance required.] 13.❑Other LAny applicant that checks box must also fill out the section below showing their workers'compensation policy information. eowners who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. actors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 117M an employer that is provlding workers'compensation insurance for info n2ation. my employees Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: Gv ��l Expiration Date: Job Site Address:r City/State/Zip: O/ ap Attach a copy of the-workersco pensation policy declaration page(showing the policy number and expiration date0/t�'YS Failure to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition of criminalpenalties 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 maybe forwarded to the Office of Investigations of the D9 for insurance coverage verification. t do hereby cert y u tIz sins and enalties o P fperjury that the inforrzzation provided above is true and correct. >i nature: 2 Date: p `:none#: 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): Y.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.PIumbing Inspector 6.Other Contact Person: Phone M.